Combo set 2
What will happen with a severed nerve with no connection to the distal segment and no surgical repair?
"Dying back" of axon extending into cell body with cell death Complete absence of nerve conductance and EMG profuse denervation Chapter 19 - Page 230
What is involved in the ideal practice of evidence-based medicine?
"Integrating individual clinical expertise with the best available external clinical evidence from systemic research" Chapter 14 - Page 157
What is the management of symptomatic, recurrent posterolateral rotatory instability?
- Most often involves reconstruction of the LUCL complex, using either autograft or allograft. - Repair of LUCL is inferior to reconstruction because of attenuation of the native ligament tissue. Chapter 27 - Page 346
What two families of matrix catabolic enzymes (similar to articular cartilage) are involved with the degenerative process of the discs?
1. MMP-matrix catabolism 2. ADAMTS-aggregate catabolism (Interleukin-1 up regulates the 2 groups of enzymes, tumor necrosis factor-alpha may be an early response mediator) Chapter 3 - Page 30
What are two characteristics of Thrombocytopenia-Absent Radius?
1. Complete bilateral absence of radi and preservation of the thumb 2. Severe thrombocytopenia that improves if child lives beyond one year Photo shows a child with thrombocytopenia-absent radius syndrome. Ulnar bowing at the forearm and preservation of the thumb can be seen in the AP radiograph of the hand and lateral forearm. Chapter 55 - Page 698
What three conclusions were made when comparing complications with total elbow arthroplasty in rheumatoid and non-rheumatoid patients?
1. Complications after total elbow arthroplasty were rare and nearly equivalent in rheumatoid and non-rheumatoid patients. 2. The rate of revision is higher for patients with posttraumatic arthritis. 3. There were more complications and longer hospital stays in non-rheumatoid patients Chapter 27 - Page 344
What are four relative indications to treat tibial shaft fractures surgically?
1. Concomitant intra-articular fractures 2. Displaced fracture with intact fibula 3. Multiple injuries 4. Soft tissue injuries that require monitoring Chapter 37 - Page 480
Camptodactyly when familial has an autosomal dominant pattern. What is the sex predilection for the 2 types of camptodactyly?
1. Congenital type: No sex predilection 2. Adolescent type: More often girls Chapter 55 - Page 705
What are the four "C"s determining the viability of tissue?
1. Contractility 2. Color 3. Consistency 4. Capacity to bleed Chapter 5 - Page 51
What two studies can differentiate an ankle sprain from a distal physeal injury?
1. MRI 2. High-resolution ultrasound Chapter 59 - Page 757
What are the best two choices to confirm the diagnosis of a nondisplaced Salter I fracture of the distal femur?
1. MRI 2. Ultrasound Chapter 59 - Page 754
What are three pathways of the coagulation cascade?
1. Intrinsic- initiated by platelets, does not require trauma therefore" intrinsic" 2. Extrinsic- requires external trauma therefore "extrinsic" 3 Common Pathway Chapter 12 - Page 138
Acute traumatic forces cause primary injury to the spinal cord. Describe four secondary pathophysiologic processes that cause secondary damage.
1. Ischemia 2. Excitotoxitity 3. Inflammation 4. Oxidative Stress It is evident that these are important contributors to further neural damage and axonal retraction at the cord injury site, but also for mediating the development of neuropathic pain and infection. Chapter 44 - Pages 575-576
What six risk factors place THA and TKA patients into a low risk VTE group?
1. Class 1 CHF (NY Heart Association system) 2. Prior DVT more that 5 years ago 3. Inactive cancer 4. Current hormone replacement therapy (HRT) 5. Chronic tobacco use 6. Blood diseases: sickle cell TRAIT, polycythemia vera, thrombocytopenia Chapter 12 - Page 140
What is the initial treatment for an acute shoulder dislocation? Give two treatments.
1. Closed reduction in ER 2. Closed or open reduction in OR if ER treatment unsuccessful Chapter 24 - Page 300
What two differences were shown when comparing irrigation of wounds with bacitracin solution vs castile soap?
1. No significant difference in infection 2. Increased wound healing complications with bacitracin 9.5% vs 4% Chapter 5 - Page 50
What are three risks of steroids when used in muscular dystrophy?
1. Obesity 2. Osteopenia leading to fractures 3. Behavioral changes Chapter 63 - Page 818
Give three examples of continuous variables.
1. Outcome scores 2. Laboratory values 3. Range of motion Chapter 15 - Page 167
What are two characteristics of patients who typically have symptomatic valgus instability?
1. Overhead athlete (ie, thrower). 2. Typically baseball player. Chapter 27 - Page 346
In cases of peroneus brevis tears, what are two indications for repair versus tenodesis with peroneus longus?
1. Primary repair and tubularization are indicated for tears involving less than 50% of the tendon 2. Tenodesis is indicated for tears involving more than 50% of the tendon Chapter 40- Page 528
The presence of nerve growth factors, neuropeptide substance P and interleukin-1 beta found in the nucleus pulposus suggest what two possibilities?
1. Pro-inflammatory cytokines stimulate nociception 2. Pro-inflammatory cytokines stimulate pain response via nerve ingrowth Chapter 3 - Page 30
What are two electrodiagnostic findings of compressive neuropathies?
1. Prolonged latencies 2. Slowing of nerve conductance velocity
What are three characteristics of successful outcome with ankle arthroplasty?
1. Proper patient selection 2. Restoring bony alignment 3. Restoring soft tissue/ligament balance Chapter 40 - Page 524
Name four important characteristics of high-quality case series.
1. Prospective data collection, including all patients 2. Using validated outcome measures 3. Using independent outcome assessors 4. Has a high follow-up rate Chapter 15 - Page 171
What are three postoperative management recommendations for posterolateral rotary instability?
1. Protect from varus stress across the elbow 2. Avoid shoulder abduction 3. Early motion Chapter 27- Page 346
What is the acceptable treatment for hip dislocation with posterior wall fragment involving 20-50% of the wall?
Examination under anesthesia 1.Hip is flexed to 90° with slight adduction, internal rotation while applying posterior directed 2. Concentric reduction of the hip must be maintained to determine stability Chapter 31 - Page 401
Posterior hip dislocation with a 30% posterior wall fragment can be treated how?
Examination under anesthesia and if stable consider arthroscopy at the same setting Chapter 31 - Page 401
Ambulatory patients with lower level lesions with hip flexion contractures compensate in what way in the lumbar spine?
Excessive lumbar lordosis Measured by Thomas test combined with sagittal Cobb angle X-ray Chapter 63 - Page 817
What is a Level 5 study?
Expert opinion without the support of clinical data Chapter 14 - Page 159
What key joint lubrication protein lowers surface friction?
Lubricin Bovine study with immunolabeling with different mechanical environments. LG1= compression; LG2 = compression and sliding motion (stain for lubricin) Chapter 3 - Page 23
What is the definition of a major curve and minor curve?
Major curve: Structural, larger more rigid, more progressive Minor curve: Nonstructural, smaller, compensatory more flexible Chapter 45 - Page 588
What is the male to female ratio in Legg-Calve-Perthes disease?
Male predominance, 5:1 Chapter 58 - Page 744
What was the main difference between reamed and unreamed nailing of the tibia in the SPRINT (Study to Prospectively Evaluate Reamed Intramedular Nails in Patients with Tibial Fractures) trial?
More autodynamization and screw breakage in the unreamed
What is the treatment for non-or minimally displaced tibial eminence fracture (Type I and II)?
Nondisplaced: Cast immobilization Minimally displaced: Closed reduction and cast immobilization Chapter 61 - Page 785
What are the significant complications for or encountered with the use of NPWT)?
None Chapter 5 - Page 52
Children 6 years old and younger with a Neer-Horowitz type III and IV proximal humerus Salter II fracture should be treated how?
Nonsurgically (Great potential for remodeling) Chapter 53 - Page 676
Pipkin-type II does involve significant portion of the weightbearing surface of the femoral head therefore can be treated how?
ORIF Anterior (Smith-Petersen) or anterior lateral approach (Watson-Jones) Chapter 31 - Page 401
Pipkin-type III, the femoral head fracture also has a femoral neck fracture therefore can be treated how?
ORIF Anterior (Smith-Petersen) or anterior lateral approach (Watson-Jones) Chapter 31 - Page 401
What is the treatment for a supracondylar humerus fracture which is not reducible closed?
ORIF Most common with type IV extension type or flexion types Chapter 53 - Page 678
Given the risk of avascular necrosis with delayed diagnoses of displaced lateral condyle fracture, how does this change the surgical plan?
ORIF is performed for union not anatomic reduction. (Fixed in position to provide the best range of motion) Chaper 53 - Page 681
What condition increases the risk of ankle injuries in children?
Obesity Chapter 59 - Page 757
Name the single greatest risk factor for SCFE, as well as other risk factors.
Obesity 75% of children are above 90th percentile in weight - Boys > girls - African, Hispanic, Native American descent Radiographs showing an unstable SCFE (from OKU 10). Chapter 58 - Page 745
Structural properties are dependent on material properties and what?
Object size and shape Chapter 6 - Page 61
What is thrower's elbow overuse syndrome at the medial elbow?
Overuse syndrome of the medial epicondyle with either apophysitis or avulsion fracture Older child: Ulnar collateral ligament tear Chapter 61 - Page 789
What is the initial treatment for atraumatic patella instability?
PT and bracing Chapter 35 - Page 461
What kind of tendon transfer can be used for irreparable anterosuperior cuff tears with an irreparable subscapularis?
Pectoralis major Pectoralis major tendon transfer (2 techniques: 1. Superficial to conjoined tendon 2. Deep to the conjoined tendon-both groups with improved outcomes) Chapter 24 - Page 308
What constitutes a Grade C recommendation in clinical practice guidelines?
Poor quality evidence in more than one Level 4 or 5 study or a single Level 2 or 3 study for or against recommending intervention. Chapter 14 - Page 161
How do the results of rotator cuff repair compare with stable or unstable meso-os acromiale?
Poorer outcomes Meso-os acromiale Chapter 24 - Page 304
What is the primary restraint to external rotation of the tibia?
Popliteofibular ligament Chapter 35 - Page 455
What are two functions of articular cartilage?
1. Provides nearly frictionless movement of joints 2. Protects underlying bones to distributes loads across joints Chapter 3 - Page 23
Name five components of a transtibial amputation prosthesis.
1. Socket/Suspension (Patella tendon bearing or total surface bearing) 2. Sleeve or pin/shuttle 3. Liner (Gel or soft foam) 4. Foot (flexible, multiaxial or energy storage) 5. Pylon-Exoskeleton or Endoskeleton Below-knee prosthesis Chapter 41 - Page 544
What are two most common symptoms of child abuse?
1. Soft tissue injury (bruises, burns) 2. Fractures Chapter 57 - Page 731
Immunocompromised patients with diabetes, RA, cancer, or those undergoing steroid treatments are at increased risk for joint infection with which two organisms?
1. Staph Aureus 2. Gram negative bacilli Chapter 18 - Page 221
What are two most common causes of infectious arthritis in adults?
1. Staph aureus 2. Neisseria gonorrhoeae Chapter 18 - Page 221
What two complications are associated with open reduction internal fixation of displaced radial neck fractures?
1. Stiffness 2. Avascular necrosis Chapter 53 - Pages 682
The E-modulus for titanium is approximately half of that of stainless steel. Metal alloys have isotopic material properties that have the same properties no matter from what direction the compressive force is applied. Define and describe an anisotropic material.
1. Stiffness of a material is variable based on direction of loading 2. Cortical bone is an example, stiffness is 50% greater when loaded in the longitudinal direction compared to bending Chapter 6 - Page 60
Which three antibiotics are frequently used in an antibiotic bead delivery system and why?
1. Tobramycin 2. Vancomycin 3. Ancef Because they are all: 1. Water soluble 2. Heat stable 3. Well tolerated 4. Broad spectrum Figure shows an antibiotic bead pouch. Chapter 5 - Page 51
Name two surgical techniques that spare the physis in ACL reconstruction.
1. Trans-epiphyseal ACL reconstruction (avoids femoral and tibial physes) 2. Autogenous Iliotibial band technique Autogenous iliotibial band technique Chapter 61 - Page 786
What are the contraindications for a Pavlik harness?
A child with spina bifida or spasticity Chapter 58 - Page 741
Define disk degeneration.
A condition of structural failure and irreversible loss of biomechanical function through physical and biological mechanisms Chapter 3 - Page 29
What constitutes a Level 1 therapeutic study?
A high-quality randomized controlled trial (RCT) Chapter 14 - Page 159
What three factors of a cemented femoral stem improve the survivorship?
1. Trapezoidal shape 2. No sharp corners 3. Smooth to matte finish Chapter 32 - Page 422
What are the 3 tenets of displaced pediatric femoral neck fractures?
1. Urgent anatomic reduction (closed or open via anterior or anterolateral) 2. Stable internal fixation 3. External immobilization (Decompression of capsule may decrease the risk of AVN) Chapter 57 - Page 729
What is the treatment indicated for Types II lateral humeral condyle fracture?
Closed reduction and pinning if reduced to less than 2 mm displacement. If > 2 mm displacement post reduction, then ORIF is necessary Chapter 53 - Page 680
What is the treatment for a Monteggia fracture - dislocation?
Closed reduction of the ulna diaphyseal fracture usually reduces the radiocapitellar dislocation (If not, open reduction via lateral approach with preservation or repair of the annular ligament). Chapter 53 - Pages 681-682
What is the acceptable treatment for hip dislocation with posterior wall fragment less than 20% of the wall?
Closed reduction only without fluoroscopic examination under anesthesia Chapter 31 - Page 401
What treatment is indicated with Type I supracondylar humerus fracture with comminution medially?
Closed reduction percutaneous pinning to prevent cubitus varus deformity AP radiograph showing a minimally displaced supracondylar fracture with medial comminution. The fracture was not reduced, and the patient developed cubitus varus requiring supracondylar osteotomy. Chapter 53 - Pages 677-679
After 6 months of age, what treatment can be attempted (conservative) for DDH?
Closed reduction with spica casting (100 deg flexion, 45 deg abduction, neutral rotation) x 6 weeks Chapter 58 - Page 742
What is the accuracy rate in determining vertebral osteomyelitis for Gallium Ga - 67 citrate when performed with a bone scan?
94% Chapter 43 - Page 566
What the portion of supracondylar fractures are extension type?
97% Chapter 53 - Page 677
The key factors in determining the stability of atlas fractures are dependent on the fracture pattern and the integrity of what?
TAL (transverse atlantal ligament) Chapter 48 - Page 625
How sensitive are technetium bone scans for stress fractures?
They are extremely sensitive for diagnosing stress fractures, including fractures of the tibia, and pars interarticularis in the lumbar spine Chapter 8 - Pages 98-99
How do the rates of DVT and PE compare between THA and TKA?
The DVT rate is 2-3 times higher for TKA vs THA patients. The rate of PE is the same. Chapter 12 - Page 138
What is evaluated in a therapeutic study?
The effect of treatment on the outcome of disease Chapter 14 - Page 159
How long will a fracture continue to be positive on bone scan?
They may remain positive for up to 3 years after a fracture because of ongoing bone remodeling Chapter 8 - Pages 98
What is the difference between Tillaux and Triplane Fractures?
Tillaux fracture is an intra-articular Salter-Harris III fracture of the antero-lateral tibial physis is avulsed with the anterior tibiofibular ligament due to an external rotational force. (Picture #1) Triplane fracture are SH type IV that occur in both sagittal and coronal planes; different variants exist. (Picture #2) Chapter 59 - Page 757
Transverse atlantal ligament injuries are divided up into-Type I (bony avulsion) and-Type II ligamentous injury. Which type should heal with nonsurgical treatment?
Type II Given bony avulsion expected to heal with nonsurgical intervention Chapter 48 - Page 625
When performing a closed reduction of a dislocated lower cervical spine, what is the weight limit that can be applied to cranial tongs?
The general recommendation is up to 2/3rds of the patient's body weight, however, many graphite based tongs have a fixed limit of approximately 80 lbs Chapter 48 - Page 627
What is the endurance limit of a material?
The highest dynamic load amplitude at which no failure will occur regardless of the number of loading cycles Chapter 6 - Page 69
If the P value equals 50 what is the significance of that study of 2 groups (i.e. control group and treatment group) that had a difference in results?
There was a 50% probability that the difference in results of both groups was by chance. Not a good study!! Chapter 15 - Page 172
What are the mechanisms which make mechanical prophylaxis effective?
These devices are thought to increase finbrinolysis, as well decrease venous stasis. Blue arrow are activation and red arrow are inhibition Chapter 12 - Page 138
How common is DVT after amputation?
DVT rate ranges from 11-50% Prophylaxis is warranted Chapter 41 - Page 540
What is the advantage of minimally invasive or submuscular plating of the tibial?
Decrease wound healing issues Chapter 37 - Page 481
In long fusions to L5 in adult scoliosis (mean age. equals 45 years), what is the rate of degeneration of L5-S1 and what is the rate of re-operation with fusion to the sacrum?
Degeneration: 69% Re-Operation: 23% (additional 19% recommended but not medically cleared for surgery) Chapter 45 - Page 588
What are the concerns of using iliac crest grafting for anterior glenoid defects?
Degenerative changes from femoral head articulating with graft (High rates patient satisfaction reported with this procedure) Tricortical iliac crest bone graft of glenoid defect Chapter 24 - Page 302
Insertional activity and baseline activity provide viable information in regard to the health of the muscle and its innervation. Observation of the motor unit potentials (MUPs) are done by looking at the insertional activity, baseline activity, slow contraction and maximum contraction EMG patterns. There are several abnormal potentials which can be diagnostic. What major disorder are positive sharp waves, fibrillation and fasciculation associated with?
Denervation (Fibrillation and positive sharp waves can also be associated with myopathy) A. Fibrillation* and positive sharp waves** B. Neuromyotonic discharges, single, doublet, triplet C. Fasciculation (ALS) D. Myotonic discharge (dystrophia myotonica) Clinical Nerve Conduction and NeedleElectromyography Studies Donald H. Lee, et al. J Am Acad Orthop Surg July/August 2004; 12:276-287. Chapter 19 - Page 229
What does the Ortolani test detect?
Detects the presence of a dislocated, but reducible hip in abduction 1. Ortolani = palpable reduction of a displaced hip in the flexed/abducted position. 2. Barlow = subluxation of the hip with posterior force on a flexed/adducted thigh Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 740 Chapter 58 - Page 739
What does the Barlow test detect?
Detects the presence of a subluxable hip in adduction 1. Ortolani = palpable reduction of a displaced hip in the flexed/abducted position. 2. Barlow = subluxation of the hip with posterior force on a flexed/adducted thigh Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 740 Chapter 58 - Page 739
What are the two most common causes of lower extremity amputation in developing nations and developed nations?
Developing nations: 1. Trauma 2. Infection Developed nations: 1. Vascular disease 2. Diabetes 3. Chapter 41 - Page 537
What is the definition of cerebral palsy?
Developmental disorders of movement and posture causing activity limitations due to disturbances occurred in the developing fetus or infant brain The encephalopathy is static but the musculoskeletal system changes with development Chapter 63 - Page 811
Ambulatory cerebral palsy patients have a greater tendency for obesity compared to nonambulatory patients. What is the impact of the extra weight?
Diminished ambulatory efficiency Chapter 63 - Page 813
What is a hip pointer injury?
Direct blow to the iliac crest (tissues crushed against edge of crest) or greater trochanter with muscle and bone contusion and bleeding into abdominal muscles and gluteal muscles and sometimes fracture. Very painful because of superior clunal nerve being crushed against iliac crest. Chapter 61 - Page 788
What is the most common reason for lack of concentric reduction in elbow dislocations in skeletally immature patients?
Displaced medial epicondyle fragment intra-articular Medial Epicondyle Fractures in the Pediatric Population, Hilton P. Gottschalk, J Am Acad Orthop Surg April 2012 ; 20:223-232.;doi:10.5435/JAAOS-20-04-223 Chapter 61 - Page 787
What is the most important radiographic clue to aid in diagnosing a Monteggia fracture dislocation?
Disrupted radiocapitellar line on the lateral elbow radiograph On every lateral view the elbow a line drawn down the radial shaft should pass through the center of the capitellar ossification center Chapter 53 - Page 681
What is valgus instability of the elbow?
Disruption of the MCL (specifically the anterior band of the MCL): Chapter 27 - Page 346
Treatment of severe bunions by proximal osteotomy must be accompanied by what procedure?
Distal soft tissue release (modified McBride) Chapter 40- Page 526
What is the knee Stener lesion?
Distal superficial MCL tear that is displaced superficial to pes tendons (which prevents healing) Chapter 35 - Page 454
There are two major pathways of sensation from the periphery to cerebral cortex. Both pathways consist of three neurons. What are the names of both major pathways and describe the three neuron pathways of each?
Dorsal column : First neuron/Heavily myelinated sensory nerves (Proprioception, fine touch and vibration) transgress dorsal root (nucleus at dorsal root ganglion) enter dorsal column where it ascends to the medulla oblongata (brainstem) where it synapses with 2nd neuron Second neuron crossed to other side in brain stem then travels up to thalamus (relay switch in brain) where it synapses with third neuron Third neuron travels to primary sensory cortex Spinothalamic tract: First neuron/Non-myelinated sensory nerves (Pain, temperature and crude touch) transgress dorsal root (nucleus at dorsal root ganglion) enter dorsal column where it either ascends or descends 1-2 vertebral levels passes thru dorsal horn and synapses in central cord with second neuron. Second neuron crosses over to other side of spinal cord where it ascends in lateral spinothalamic tract or anterior spinothalamic tract. Second neuron synapses in thalamus (relay switch) with third neuron Third neuron travels to somatosensory cortex (parietal lobe) Chapter 19 - Page 226
Frederick's ataxia is a autosomal recessive disorder of the spinal cord with progressive weakness and scoliosis. What part of the spinal cord is predominantly involved?
Dorsal columns (progressive sensory ataxia) Sensory ataxia definition: Loss of coordination caused by loss of sensory input into the control of movement not by cerebellar dysfunction. Lose balance when closing eyes. Chapter 19 - Page 234
The gray matter of the spinal cord contained longitudinally arranged neuronal cell bodies, glial cells, dendrites and myelinating and non-myelinating axons. What makes up the dorsal horn and the ventral horn in regard to motor and sensory?
Dorsal horn: Predominantly sensory Ventral horn: Purely motor Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 226 Chapter 19 - Page 226
What is the most common type of muscular dystrophy?
Duchenne Muscular Dystrophy 1. X-linked recessive 2.One third new mutations Chapter 63 - Page 818
Test loading can be done statically (loading is gradually increased until failure occurs) or dynamically. Which is more representative with fixation failure, implant migration, wear and fatigue?
Dynamic loading (New approach: Progressive loading with increased amplitude) Static load, dynamic load and progressive dynamic load Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 67 Chapter 6 - Page 67
How are recommendations evaluated in clinical practice guidelines?
Each recommendation carries a level of evidence derived from the data underlying the recommendation as well as a grade of recommendation. Chapter 14 - Page 161
With early osteoarthritis, what is seen occurring with the chondrocytes early and then late?
Early: Increased apoptosis (preprogrammed cell death, normal lifecycle versus necrotic traumatic cell death) Late: Hypocellularity Electron microscope: normal cells (A-C, from unloaded cartilage), necrotic cells (D-F, from cartilage subjected to freeze-thaw cycles), and apoptotic cells (G-I) Chapter 3 - Page 25
Which MRI findings may help predict eventual neurologic outcome?
Edema and hemorrhage within cord parenchyma (The extent of edema and hemorrhage that extended above and below the main spinal cord injury) Acutely hemorrhage appears dark on T2 views. Its presence traditionally is a poor prognostic sign. Chapter 44 - Page 575
What is the electrodiagnostic studies of myopathies?
Effect Amplitude of motor nerve Chapter 19 - Page 230
What is the association of stress fractures due to osteopenia and endurance athletes?
Endurance athletes can have osteopenia (decreased bone volume) due to inadequate food consumption therefore diminished nutritional intake Women endurance athletes have an increase in bone loss (unchanged with Vitamin K or Estrogen treatment) Lavienja A. J. Factors Affecting Bone Loss in Female Endurance Athletes: A Two-Year Follow-Up Study Am J Sports Med November 2003 31 889-895 Chapter 61 - Page 792
What is the "ring sign" with gadolinium contrast MRI pathognomonic for and what does it distinguish?
Epidural abscess (distinguished from neoplasm) Ring enhancing lesion Chapter 43 - Page 570
What is interrater reliability?
Evaluates the consistency of grade assignment between different raters Chapter 14 - Page 160
Name the type of randomized control trial that first randomizes a patient to a particular expert surgeon for the treatment.
Expertise-based design. Limitation is that results may not be generalizable because treatment is being performed by an expert in the field. Chapter 15 - Page 170
Significant hamstring contracture (popliteal angle greater than 90°) in a non-ambulatory patient can result in difficulty sitting as a result of what position of the pelvis?
Extension of the pelvis (corrected by hamstring lengthening) Popliteal angle (<90° therefore no difficulty sitting) Chapter 63 - Page 814
Why is it important to obtain a CT scan on a chronic posterior shoulder preoperatively?
Extent and location of bone loss at humerus and glenoid Chapter 24 - Page 303
What is the preferred treatment for patients with tibial shaft fractures who cannot tolerate extensive surgery or have soft tissue compromise?
External fixation Chapter 37 - Page 481
What is the position of the hip that results in anterior dislocation with femoral axial loading?
External rotation and abduction Chapter 31 - Page 399
What exam evaluates for weakness of the infraspinatus?
External rotation lag test Chapter 24 - Page 304
What is the typical position of the lower extremity when an anterior hip dislocation is present?
External rotation, some flexion, and abduction (no other ipsilateral fracture/dislocations). On imaging the lesser trochanter will be more visible than on the contra-lateral side since it is externally rotated and the femoral head may appear larger since it is further from the x-ray cassette. Chapter 31 - Page 400
If an MRI cannot be used to rule out vertebral osteomyelitis or is inconclusive, what study should be done?
FDG (fluorodeoxyglucose) - PET scan FDG is a glucose analogue (primarily used for malignancy workup, can be used for infection given increased glucose metabolism Chapter 8 - Pages 99
What study is highly accurate staging sarcomas?
FDG-PET CT 88% sensitivity in nodal staging 92% sensitivity in detecting distant metastases Limited sensitivity in detecting lung metastases <1 cm Effective in chemotherapy response (FDG uptake) Figure A shows maximum-projection whole body image shows normal distribution of FDG in the brain, myocardium, liver, spleen, kidneys, bone marrow, and neck muscles. B and C, representative transaxial PET CT images of the sarcoma. There is intense uptake of FDG in the high-grade left gluteal sarcoma (orange arrow in A and B), which also includes areas of decreased uptake in the center of the tumor, consistent with central necrosis. There is also a focus of increased uptake at the L5 vertebra (black arrow in A and C) with an underlying small lytic lesion on CT, which is consistent with metastasis. Chapter 8 - Page 101
What whole body scan is used for sarcoma workups?
FDG-PET scan Sensitivity 80% or greater for all histologic types False-negative seen in synovial sarcoma, liposarcoma, chondrosarcoma and osteosarcoma Cannot be used for grading sarcomas Chapter 8 - Page 100
Name the type of RCT that compares two interventions within the same study group including interaction between the two treatments.
Factorial design 1 Illustration of a factorial trial design. Patients are randomized to either treatment A, treatment B, or control. The red arrows denote analysis 1: treatment A versus control. The blue arrows denote analysis 2: Treatment B versus control. With this trial design, the same study population is used for two interventions and analyses. Chapter 15 - Page 169
Syndactyly, Camptodactyly, Kirner Deformity, Congenital Synostosis and Sprengel deformity or all of what primary classification of congenital anomalies?
Failure of Differentiation Chapter 55 - Page 704
A cleft hand is due to failure of what?
Failure of formation of the center of the limb(Central Deficiency) Congenital anomaly including short digits, cutaneous syndactyly and global hypoplasia of the hand (or foot) Chapter 55 - Pages 700-701
What is the definition of myelomeningocele?
Failure of neural tube closure Chapter 63 - Page 816
What constitutes a Grade B recommendation in clinical practice guidelines?
Fair quality evidence in more than one Level 2 or 3 study with consistent findings or a single Level 1 study for or against recommending intervention. Chapter 14 - Page 161
What is the most common cause for a femoral shaft fracture in children < 10?
Fall Chapter 57 - Page 731
What is meant by "type II error" or beta error?
False-negative No difference was found between the treatments groups when there was actually a difference between the groups. Acceptance of the null hypothesis when the hypothesis is false (I or II remember p has 1 line and n has 2) Chapter 15 - Page 172
There are two types of error. What is meant by "type I error" or alpha error?
False-positive error A difference was found between the treatment groups when actually there was no difference. Rejection of a null hypothesis when the hypothesis is true Remember type I error= false Positve and type II error = false Negative (I or II remember p one line and n has two) Chapter 15 - Page 172
Madelung's deformity is usually sporadic but can be inherited and associated with different syndromes. A similar deformity can result from repetitive ballistic loading of the wrist, what sport can this deformity be seen in?
Female Gymnist Chapter 55 - Page 710
What is the treatment for a periprosthetic fracture with a loose femoral component?
Femoral component revision with a cementless stem, bypassing the fracture site with fixation in the diaphyseal bone Vancouver Classification for Periprosthetic Fractures of the Femur Type A Pertrochanteric fracture AL Fracture of the lesser trochanter AG Fracture of the greater trochanter Type B Fracture around the femoral component B1 Femoral component well-fixed B2 Femoral component loose B3 Femoral component loose with severe loss of femoral bone stock Type C Fracture distal to the femoral component Chapter 32 - page 427
What is the position of the hip that results in a posterior dislocation with femoral axial loading?
Flexed and adducted Chapter 31 - Page 399
Frederick's ataxia is autosomal recessive (both parents are carriers). It is a defect of chromosome 9 but which mitochondrial protein is defective?
Fraxatin protein deficiency Fraxatin is a protein in neuronal mitochondria which is important in metabolism of iron. In Frederick's ataxia, iron accumulates in the mitochondria in nerve tissue Iron accumulation in the dentate in patients with Frederick's ataxia compared to controls Chapter 63 - Page 820
What surgical treatment has not been proven feasible in the intermediate and long term for treatment of ankle arthritis?
Fresh osteochondral total ankle allograft Chapter 40 - Page 523
Is casting or functional bracing shown to be superior for non-displaced fibula fractures (Salter-Harris type I or type II)?
Functional bracing Chapter 59 - Page 758
What happens if the ABI is < 0.9% with a knee dislocation?
Further vascular screening is needed with arterial duplex and/or CT arteriography Chapter 35 - Page 458
What treatment is effective for scoliosis with Friedreich's ataxia?
Fusion with instrumentation Bracing not indicated Chapter 63 - Page 820
What constitutes a Grade A recommendation in clinical practice guidelines?
Good quality evidence in more than one Level 1 study with consistent findings for or against recommending intervention. Chapter 14 - Page 161
For posteromedial instability what are the results of secure fixation of the anteromedial facet of the coronoid?
Good to excellent elbow function Chapter 27 - Page 346
What are four grades of osteoarthritis in the Tonnis classification?
Grade 0: No signs of osteoarthritis Grade 1: Increased sclerosis of head and acetabulum Grade 2: Small cysts in the head or acetabulum, moderate joint space narrowing, moderate loss of head sphericity Grade 3: Large cysts in head or acetabulum, severe joint space narrowing or obliteration, severe deformity of the head, evidence of necrosis Chapter 32 - Page 416
What antibiotics regimens are recommended for treatment of open fractures based on the Gustillo-Anderson Classification?
Grade 1 or 2: First or second-generation cephalosporin Grade 3: Cephalosporin plus aminoglycoside Grade 3 with soil contamination: Add penicillin Chapter 37 - Page 484
Pedicle subtraction osteotomy resection is equivalent to two adjacent Smith-Petersen resections then resecting the pedicles and the vertebral body. This osteotomy hinges on the anterior vertebral cortex. What is the indication for the pedicle subtraction osteotomy in adult scoliosis?
Greater than 12 cm of sagittal imbalance Sagittal Plane Deformity in the Adult Patient Samuel A. Joseph, et al. J Am Acad Orthop Surg June 2009 ; 17:378-388.
Hip dysplasia is common in meningomyelocele. What is the indication for hip flexion contracture release in an upper level meningomyelocele with no hip motor control?
Greater than 20° hip flexion contracture Chapter 63 - Page 817
The ZPA produces gremlin protein (inhibitor of transforming growth factor beta pathway) and the limb mesoderm produces gremlin and bone morphogenic protein. How does gremlin protein and BMP interact in limb development?
Gremlin has a antagonistic effect on BMPs preventing premature limb maturation and cessation of longitudinal development. Chapter 55 - Page 697
Malnutrition is seen in patients with cerebral palsy particularly in GMFCS groups III, IV and V. Why is this the case with groups IV and V?
Groups IV and V have gastrointestinal disorders therefore malnutrition 1. GERD 2. Gastric motility diminished 3. Constipation 4. Gastric tube feeding (Also feeding issues with difficulty eating and swallowing) Gastrointestinal and Nutritional Issues in Cerebral Palsy, John F. Pohl M.D. www.practicalgastro.com/pdf/May06/PohlArticle.pdf Chapter 63 - Page 813
What is the most common acquired inflammatory demyelinating neuropathy?
Guillain-Barré Chapter 19 - Page 232
What is the H-reflex study?
H-reflex study is a true reflex with stimulation of sensory fiber and recording of muscle response. This is typically done at the S1 level using the soleus muscle. a =F-wave study, b = H-reflex study Chapter 19 - Page 229
Releasing the adductor tendon in the distal soft tissue release (bunion correction) can result in what iatrogenic deformity?
Hallux varus Chapter 40 - Page 526
Which muscle tendon unit is injured with an apophyseal avulsion of the ischial tuberosity?
Hamstring Chapter 61 - Page 788
Separation of the long and ring finger can be delayed until the hand is larger. What is the reason for delaying surgery compared to border digits?
Hand is larger and easier to reconstruct Chapter 55 - Page 704
Due to the inherent limitations of standard cervical spine radiographs, what imaging modality has replaced it in the emergency department?
Helical cervical spine CT Chapter 48 - Page 624
What are the current treatment recommendations for Garden type III and IV femoral neck fracture in an elderly patient?
Hemiarthroplasty There is now evidence that supports the use of a THA for functional elderly patients with displaced femoral neck fractures and using hemi-arthroplasties for less demanding/ functional elderly patients Chapter 31 - Page 404
What type of outcome occurs with primary ACL repair?
High failure rate Chapter 35 - Page 453
What is the sensitivity and specificity of the ESR and CRP tests with infected total hips?
High sensitivity if both tests are done Chapter 32 - Page 426
Are hip dislocations high or low energy injuries?
High. Chapter 31 - Page 399
What is the healing rate for meniscus tears with concurrent ACL tears?
Higher Chapter 35 - Page 459
Is disease transmission (hepatitis B and C. and HIV) after donor-directed blood higher or lower than after autologous blood?
Higher Family members and friends are reluctant to disclose hepatitis and HIV status Therefore donor directed donations are rarely used Chapter 12 - Page 141
Which has a better outcome for shoulder dislocation, arthroscopic or open reconstruction?
Historically: Open methods- lower redislocation rate Recent studies: Suggest arthroscopic-at least equal outcomes to open reconstruction Chapter 61 - Page 788
What test evaluates for weakness of the teres minor?
Hornblower sign Examiner places patient's arm in 90° abduction, 90° external rotation; patient unable to maintain external rotation. Weakness on left. Chapter 24 - Page 304
Involvement of the lower plexus (C8 to T1), Klumpke Palsy can result in what facial finding?
Horner syndrome (involvement of the cervical and or thoracic sympathetic chain) Ptosis-drooping eye lid Miosis-constricted pupil Enophthalmos-appearance of sunken eyeball Anhidrosis-dry ipsilateral face leading to red sclera Chapter 55 - Page 710
The earliest changes of OA usually appear in what structure in a joint?
Hyaline cartilage Chapter 18 - Page 213
For osteosynthetic constructs, insufficient stiffness can lead to what type of non-union?
Hypertrophic non-union Chapter 6 - Page 68
The Crowe classification describes the amount of subluxation of the hip. Give the four grades.
I. < 50% subluxation II. 50-75% subluxation III. 75-100% subluxation IV. > 100% subluxation Crowe classification includes vertical distance measurement from inter- teardrop line to the junction femoral head and medial edge of the neck. Amount of subluxation = vertical distance/vertical diameter of a deformed femoral head (distance divided by diameter). Chapter 32 - Page 418
What are five classifications of Gross Motor Functional Classification System?
I. Ambulate with no limitations, able to do running and jumping with speed, balance and coordination reduced II. Ambulate in community independently but limited running and jumping and uneven surfaces III. Dependent ambulators and wheelchair for prolonged distances or uneven surfaces IV. Home ambulators and community wheelchair dependent V. Non--ambulator United Cerebral Palsy Research and Educational Foundation, USA. Chapter 63 - Page 812
What are four radiologic stages of Legg-Calve-Perthes disease?
I. Initial (widening of joint and mild symptoms up to 6 months) II. Fragmentation(crescent sign progressing to the dissolution of the epiphysis, 6 months to 2 years) III. Reossification (new bone formation, up to 18 months) IV.Remodeling or Healing (bone density and trabecular pattern normalizes) Crescent sign on frog-leg lateral indicating the onset of Fragmentation Stage Chapter 58 - Page 745
What are three classes of the Seddon classification?
I. Neuropraxia: Myelin sheath is damaged and intact axon, endoneurium, perineurium and epineurium are intact (full recovery in days and weeks)-no Wallerian degeneration II. Axonotmesis: Loss of continuity of axon and possibly it' s myelin covering with preservation of connective tissue framework-Wallerian degeneration (incomplete recovery) III. Neurotmesis: Complete severance of entire nerve fiber with "dying back" at proximal segment and Wallerian degeneration of distal segment Chapter 19 - Page 228
What are five Stulberg classifications used to assess joint congruity at skeletal maturity?
I. Normal Hip II. Spherically Congruent (spherical femoral head +- larger with short neck or abnormal acetabulum) III. Aspherically congruent (non-spherical ovoid, mushroom or umbrella shaped head) IV. Aspherically congruent (flathead and flat acetabulum) V. Incongruent (flat or deformed head with different shaped acetabulum) I and some II function do well throughout life Chapter 58 - Page 746
What strains of bacteria are you most concerned with grades I-III open fractures?
II and II: Staphylococcus aureus, streptococci, and aerobic gram negative bacilli III: more gram negative bacilli Chapter 5 - Page 50
What drug has proven to be effective in Frederick's ataxia in regard to cardiac and neurologic function but not helpful with scoliosis or pes cavovarus?
Idebenone (similar to coenzyme Q.-10) Trade names: Catena and Sovrima Allows reversible redux reaction to occur Also used for Alzheimer's dementia Chapter 63 - Page 820
How do you distinguish a therapeutic from prognostic study?
If a factor can be randomly allocated, it is a therapeutic study. If a factor cannot be randomly allocated, it is a prognostic study. Chapter 14 - Page 159
What is the appropriate treatment for femur shaft fractures in patients between 7 months in 5 years old with less than 2 cm of shortening?
Immediate spica cast Chapter 57 - Page 731
What is the appropriate treatment option for infant transphyseal (Delbet Type I) fractures?
Immobilization in a Pavlik harness or spica cast given great potential for remodeling Chapter 57 - Page 729
What post reduction position can reduce the labrum back to a more anatomic position?
Immobilize the shoulder in external rotation for three weeks. One study showed a clinical decrease in recurrent dislocation, another did not. Chapter 24 - Page 301
In which patient population showed IV gadolinium not to be used?
Impaired renal function Chapter 8 - Pages 95-96
What is the treatment of an atrophic nonunion of the tibial shaft?
Improved biologic enhancement through bone graft or orthobiologics Chapter 37 - Page 487
Early (less than 3 weeks) treatment of multi-ligament injuries can lead to what?
Improved functional outcomes Chapter 35 - Page 458
What benefit has been shown in the lab with double bundle ACL reconstruction?
Improved rotational stability Chapter 35 - Page 453
What is the treatment of a hypertrophic nonunion of the tibial shaft?
Improved stabilization Chapter 37 - Page 487
In one study of vertebral body resections and intraoperative neurologic monitoring what percentage of patients lost signals and how many of them regained their function postop?
In 18% of cases, MEPs were lost, and all patients' function returned to baseline. There were no permanent deficits. Chapter 45 - Page 592
How is a study appropriately powered?
In a positive trial, it must detect significant difference In a negative trial, it must be sufficiently powered Chapter 14 - Page 159
What is the advantage in multitrauma patient by obtaining a single-pass whole body CT scan?
In multitrauma patients, single-pass whole body CT scan can cover an extended area of the body more efficiently, without overlap and therefore with less radiation Chapter 8 - Pages 90-91
What is the standard treatment for unstable slipped capital femoral epiphysis?
In situ fixation using one central cannulated screw+- second screw No forceful manipulation (risk of AVN) (Emergency anterior capsulotomy-hematoma evacuation followed by gentle reduction into pre-slipped position with smooth K wire fixation has been reported) Chapter 58 - Page 746
Describe the treatment of stable SCFE.
In situ pinning (cannulated screw inserted into the center of epiphysis) with >4 threads across the physis. Full weight bearing after 4-6 weeks. Chapter 58 - Page 746
Where does pyogenic vertebral osteomyelitis originate, and why?
In the vertebral bodies near the end plate due to their relatively poor vascular supply Chapter 43 - Page 565
What effect does introducing a hollow center to a solid cylinder maintaining the same cross sectional anatomy but with a larger diameter?
Increased bending stiffness Chapter 6 - Page 61
How does the dislocation rate of total hip replacement for AVN compare to degenerative arthritis cases?
Increased risk of dislocation Chapter 32 - Page 421
Most cementless femoral components are made from titanium and have primarily metaphyseal fixation. There are two stem designs: Metaphyseal filling and Flat wedge taper design. What is a disadvantage of the flat wedge taper design?
Increased risk of interoperative and early postoperative periprosthetic fracture flat wedge tapered stem Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 423 Chapter 32 - Page 422
What is valgus extension overload of the elbow in thrower's elbow?
Increased shearing stresses on posterior medial olecranon during deceleration and deceleration phase Shearing load on posterior medial olecranon with spur formation Chapter 61 - Page 790
Why does excessive stiffness increase the risk of periprosthetic fracture?
Increased stress rises at the implant-bone interface (increase risk of fracture especially in osteoporotic bone) Chapter 6 - Page 68
Observational bias can be solved by what means?
Independent blinded assessors Chapter 15 - Page 171
The P value determines what?
Indicates that groups in a trial are statistically significantly difference. There is less than a 5% probability that the difference between the groups is by chance. The difference between the 2 groups is not by chance. Chapter 15 - Page 172
When is splinting appropriate for DDH?
Infants less than 6 months of age (Pavlik harness most common in the US) 1. Subluxable (Barlow positive) 2. Reducible (Ortolani positive) Pavlik harness Chapter 58 - Page 741
What condition must be considered in spinal infections when there is persistent bacteremia or fever with treatment?
Infective endocarditis Mitral valve vegetations Chapter 43 - Page 569
On the AP radiograph of the pelvis, the proximal medial metaphysis of the femur should be in what quadrant?
Inferior medial quadrant Proximal medial metaphysis of the femur on normal right (inferior medial quadrant) and dislocated left (not in inferior medial quadrant) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 741 Chapter 58 - Page 741
What is a preparatory prosthesis?
Initial prosthesis designed to accommodate radical changes in shape or volume through manipulation of a socket insert. Functions very similar to a final prosthesis (This differs from an immediate post-op prosthesis (IPOP), which assists in immediate gait training and volume reduction but has a lower level of function) Chapter 41 - Page 543
What triggers cell division in mature cartilage?
Injury Chapter 3 - Page 24
In using the Modified Schenck classification for Multiligamentous knee injury, the KD-II indicates which ligaments are injured?
Injury to ACL and PCL only Chapter 35 - Page 458 Chapter 35 - Page 459
In using the Modified Schenck classification for Multiligamentous knee injury, the KD-IV indicates which ligaments are injured?
Injury to ACL, PCL, PMC, and PLC Chapter 35 - Page 458
In using the Modified Schenck classification for Multiligamentous knee injury, the KD-III indicates which ligaments are injured?
Injury to ACL, PCL, and either PMC or PLC Chapter 35 - Page 458
What is the significance of a grade III posterior drawer test (tibia moves past femoral condyle) injury?
Injury to both PCL and PLC Typically managed surgically Chapter 35 - Page 457
What is the mechanism that is believed to cause femoral head osteonecrosis after intramedullary rod treatment for femoral shaft fractures in adolescents?
Injury to medial femoral circumflex artery caused by an entry point that is medial to greater trochanter (i.e. piriformis fossa) Chapter 57 - Page 734
What is the gold standard for meniscus repair?
Inside out with vertical mattress suture Vertical is also the strongest Photo of inside-out technique for meniscus repair. Chapter 35 - Page 459
What is mirror therapy and how is it beneficial in amputations?
Intact limb is used to project image over amputated limb Shown to reduce phantom limb pain Chapter 41 - Page 539
Analyzing the patients as per which group they were initially randomized is what type of analysis? Important with trials where patients switch from one treatment protocol to another.
Intention-to-treat analysis Maintains randomization and prognostic balance Chapter 15 - Page 175
In addition to standard elbow films,what other x-ray views help in assessing the amount of displacement in lateral condyle iractures?
Internal oblique radiographs AP X-ray reveals minimal displacement. Internal oblique X-ray showing significant displacement Chapter 53—Page 680
Most distal tibial physeal fractures, Salter-Harris I and II can be treated with a close reduction and long-leg casting. Occasionally an acceptable reduction cannot be obtained because of what?
Interposed periosteum (requiring open reduction with or without fixation) Chapter 59 - Page 757
What is Rho?
Intracellular signaling molecule in the axonal growth cone Regulatory when exposed to inhibitory myelin (Rho halts axonal growth cone) Oligodendrocyte (myelin) with its MAG(Myelin associated glycoprotein) activate Rho which results in growth cone collapse. By blocking Rho promotes growth cone elongation Chapter 44 - Page 576
What is the current treatment of choice for a subtrochanteric femur fracture?
Intramedullary nails are the current most commonly used implants for ST femur fractures. A fixed angle device could be used as well. Sliding hip screws are typically not used for ST femur fractures. Chapter 31 - Page 405
What is the classic radiographic change of the physis in the coxa vara?
Inverted Y. shaped radiolucency Inverted Y. coxa Vara Chapter 58 - Page 744
In using the Modified Schenck classification for Multiligamentous knee injury, the KD-I indicates which ligament is injured?
Involvement of only one cruciate Chapter 35 - Page 458
In using the Dial Test with the knee at 30 degrees of flexion, what ligamentous instability is indicated by an increase in external rotation by 10-15 degree?
Isolated PCL injury Chapter 35 - Page 455
What is the critical aspect of the LUCL graft reconstruction?
Isometric origin of the LUCL on the lateral aspect of the capitellum, This point is located in the center of the lateral face of the hemisphere of the capitellum. Docking hole placement requires the hole to be centered slightly posterior and proximal to the isometric point to keep the ligament graft tensioned in extension. Chapter 27 - Page 346
What is the benefit of tear completion for rotator cuff repair?
It allows debridement of the degenerative tendon, complete tuberosity preparation (decortication) and healthy tendon repair. (No prospective study compares in situ repair versus tear completion) Chapter 24 - Page 307
Why does the biceps need to be addressed if pathology is seen?
It is a significant pain generator Chapter 24 - Page 307
What is notable about WBC in patients with Vertebral Osteomyelitis?
It may be normal, especially in patients with indolent organisms. Chapter 43 - Page 566
Give the typical foot deformity with a L3 and L4 meningomyelocele levels.
L3 level and above: Clubfoot (paralytic) L4 level: Calcaneus deformity (unopposed pull of anterior tibialis) Chapter 63 - Page 817
What is the study of choice to rule out osteomyelitis in patients with metal fixation for fracture or arthroplasty? How is this study interpreted?
Labeled WBC Diagnostic when there is incongruity with bone marrow scan (Labeled WBC accumulate in the bone marrow therefore needs correlation with bone marrow scans if active marrow is altered by surgery or diabetic osteoarthropathy) Osteomyelitis in a patient with screw fixation for a tibial fracture. A, Bone scan of the ankle shows intense uptake in the left distal tibia (arrow). B, Labeled WBC scan shows increased accumulation of labeled WBCs in the left distal tibia (bold arrow) and in the soft tissue superficially (dashed arrow). C, Bone marrow scan of the ankles shows symmetric uptake. The radioactive marker (M) indicates the right side. The WBC accumulation in the bone is incongruent with the marrow distribution, which is consistent with osteomyelitis. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 100 Chapter 8 - Pages 99
Given that the anterior labral ligamentous periosteal sleeve avulsion is healed, why does anterior instability continue?
Labrum not in proper location to have a glenoid edge to stabilize shoulder Improper position of labrum in ALPSA Chapter 24 - Page 301
What is the most common physical finding in an entrapped medial epicondyle with an elbow dislocation following reduction?
Lack of range of motion, particularly extension Medial Epicondyle Fractures in the Pediatric Population, Hilton P. Gottschalk, J Am Acad Orthop Surg April 2012 ; 20:223-232.;doi:10.5435/JAAOS-20-04-223 Chapter 61 - Page 787
What is the Lapidus procedure and what are two indications for this bunion procedure?
Lapidus procedure: Arthrodesis of the first metatarsocuneiform joint Indications: 1. Hypermobile first metatarsal 2. Salvage procedure for failed hallux valgus surgery Chapter 40- Page 526
What is the hallmark presentation of late diagnosis of tuberculosis of the spine?
Large kyphotic deformity Chapter 43 - Page 567
When does the medial clavicle ossification center appear?
Late teenage years Chapter 53 - Page 675
Nerve conductance velocity is done by using a constant voltage stimulator (cathode) and recorder on either muscle (motor nerve) or along a nerve (sensory nerve). The latency (time from stimulation to time of recording) of the response is calculated and displayed in milliseconds. The nerve conductance velocity is the distance that the stimulus had to travel from cathode stimulus to recording electrode divided by what?
Latency Nerve conductance velocity = Distance traveled/ Latency Chapter 19 - Page 229
Juvenile osteochondritis dissecans is an acquired idiopathic disorder of the subchondral bone. There is a secondary effect on the overlying cartilage. What is the most common location in the knee?
Lateral aspect of the medial femoral condyle Juvenile osteochondritis dissecans, lateral aspect of the medial femoral condyle Chapter 61 - Page 791
Slipped capital femoral epiphysis is best diagnosed by what X-ray?
Lateral hip X-ray (AP hip X-ray with Klein line may not be useful for screening) AP hips and lateral of the involved left hip shows the typical posterior and inferior displacement of the epiphysis Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 746 Chapter 58 - Page 746
What type of meniscus tear is common is the acute ACL injured knee?
Lateral meniscus Chapter 35 - Page 453
The limb meseenchymal cells are divided up into lateral plate mesoderm and somatic mesoderm. Into what tissues, do these 2 parts develop into?
Lateral plate mesoderm-bone, cartilage and tendon Somatic mesoderm-muscle, nerve and vessels Dorsal view of a 2.11mm Human Embryo, somites segmental masses of mesoderm on each side of neural tube Chapter 55 - Page 697
What talus injury is associated with snowboarders?
Lateral process talar fractures AP view of the ankle with a avulsion fracture lateral process of the talus Chapter 59 - Page 759
What kind of tendon transfer can be used for irrepairable posterosuperior cuff tears?
Latissimus dorsi Latissimus dorsi tendon transfer for massive nonrepairable rotator cuff tear Chapter 24 - Page 308
What classification system can be used with adult scoliosis patients who are younger than 40 years to determine cephalic and caudal levels of fusion? This system is also used for adolescent idiopathic scoliosis patients.
Lenke. classification system Chapter 45 - Page 588
What is the contraindication for radiofrequency ablation in the treatment of osteoid osteoma?
Lesions that do not allow a safe distance to the major neurovascular structures Chapter 8 - Page 102
What is an abnormal ankle-brachial index suggesting vascular injury?
Less than .9 Rooke TW, et al. (2011). 2011 ACCF/AHA Focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 58(19): 2020-2045.
What is a normal Hilgenreiner epiphyseal angle (to examine developmental coxa vara)?
Less than 25 degrees (Increasing Hilgenreiner epiphyseal angle, HEA -> increased progression of varus, stress fracture, nonunion of femoral neck and hip OA) Chapter 58 - Page 744
What is the most common level for orthopaedic literature?
Level IV Case Study
What is the most reliable predictor of post amputation mobility?
Level of amputation (Not: age, sex, diabetes, ER admission, indication for amputation, prior vascular surgery) Chapter 41 - Page 537
What are the shortcomings of level of evidence rating?
Level of evidence represents an assessment of study design, but does not address the quality of data gathering or interpretation. Chapter 14 - Page 161
The judicial hanging fracture is a hyperextension distraction injury with severing of the spinal cord. The traumatic spondylolisthesis is a hyperextension axial load injury with no significant spinal cord injury given fragments separate. Then there is a rebound flexion distraction disrupting the C2-C3 disc and posterior longitudinal ligament. What are four types of hangman's fracture and their treatment approach?
Levine Classification Type I: Bilateral pars fractures with less than 3 mm of translation and no angulation. C2-C3 disc, ALL and PLL intact (collar) Type IA: Extension of one fracture line into the body therefore vertebral artery injury may be at risk (collar) Type II: C2-C3 disc and posterior longitudinal ligament disrupted therefore greater than 3 mm of translation marked angulation. Anterior longitudinal ligament intact but stripped from bony attachment (light traction in extension for reduction then halo) Type IIA: Flexion Distraction variant, Fracture line more oblique therefore no translation but angulation very unstable therefore traction contraindicated (extension and axial load) Type III: Bilateral pars fractures plus dislocation of C2-C3 facet joints therefore "free-floating inferior articular process" most common associated with neurologic deficit (open reduction with wiring or anterior plate fixation) Hangman's fractures classification Upper Cervical Spine Injuries R. Sean Jackson, J Am Acad Orthop Surg July/August 2002;10:271-280
Which test is used for lower subscapularis strength testing?
Liftoff test Normal lower subscapularis-able to maintain lift off Chapter 24 - Page 304
Most neonatal palsies are neurapraxia injuries and improve within 2 months. What is a poor prognostic indicator with brachial plexus injury?
Loss of elbow flexion at 6 months Chapter 55 - Page 710
Several large cohort studies of primary shoulder dislocation treated conservatively revealed recurrence of dislocation rates between 8% and 75%. How did this compare with previous patient-based outcomes?
Lower rates of recurrent instability Chapter 24 - Page 301
What are the advantages of reaming when treating tibial shaft fractures in the SPRINT (Study to Prospectively Evaluate Reamed Intramedullary (IM) Nails in Tibial Fractures) trials?
Lower risk of reoperation (autodynamization was considered a reoperation) Chapter 37 - Page 487
Name fourteen causes of extrinsic compression of the spinal cord or the exiting nerve root. (Acronym: MIDNIGHT)
M Metabolic 1. Amyloid deposits (nerve) I Inflammatory 2. Meningeal adhesions (nerve) 3. Arachnoiditis (nerve) D Degenerative 4. Osteophytes (both) 5. HNP (both) 6. Thickened ligaments (both) N Neoplasm 7. Neurofibroma (nerve) 8. Lymphoma (nerve) 9. Lipoma (cord) 10. Metastatic disease (cord) I Infection 11. Epidural abscess (cord) G Genetic 12. Congenital narrowing (cord) H Hemoglobinopathy (Blood) 13. Bleeding or hematoma (cord) T Trauma 14. Trauma (both) Chapter 19 - Page 228
Stress fractures of the femoral neck are not typically seen on routine X-rays. What is the best radiologic test for stress fractures not seen on routine X-rays?
MRI Chapter 31 - Page 404
What is the study of choice to rule out osteomyelitis of the spine?
MRI Chapter 8 - Pages 99
What study should be obtained if X-rays are negative with physical findings of lateral overload of the elbow?
MRI MRI: OCD of capitellum with operative findings Chapter 61- Page 790
What is the most sensitive and specific test to diagnose osteonecrosis of the femoral head?
MRI 98% sensitivity and specificity. Chapter 32 - Page 420
With ankylosing conditions (ankylosing spondylitis, DISH), name another screening test other than CT scan to rule out cervical spine injury.
MRI (able to occult fracture lines and ligamentous disruption) Chapter 48 - Page 624
What has replaced flexion extension views of the cervical spine to rule out ligamentous instability?
MRI (much safer compared to flexion extension views) Chapter 8 - Page 96
Why must MRI findings correlate with routine X-rays when evaluating tumors?
MRI alone can be misleading in suggesting a aggressive tumor Chapter 8 - Page 87
What is the most valuable imaging study for assessment of spinal cord injury?
MRI imaging Chapter 44 - Page 575
What is the standard imaging technique for Vertebral Osteomyelitis and what is the sensitivity/specificity?
MRI with gadolinium Sensitivity of 96% and specificity of 93% for Vertebral Osteomyelitis diagnosis Imaging studies of a 45-year-old man with incomplete quadriplegia due to a large epidural abscess from a C6-7 osteomyelitis. A, Midsagittal T1-weighted cervical spine image with gadolinium enhancement. B, Axial T1-weightedimage with gadolinium demonstrating a well-circumscribed enhancing epidural abscess. Chapter 43 - Page 566
What is the diagnostic imaging of choice to diagnose an epidural abscess?
MRI with gadolinium (>90% sensitivity) is preferred T1 weighted MR images pre-contrast (A,B,C) demonstrating normal signal from the cerebrospinal fluid, and post-contrast (D,E,F) demonstrating the epidural abscess (arrows) compressing the thecal sac. Chapter 43 - Page 570
What are three drawbacks of mechanical prophylaxis?
Mainly patient compliance issues: 1. Getting them on 2. Keeping them on 3. Getting them on correctly Chapter 12 - Page 138
What is the most common complication in treatment of pediatric tibial shaft fractures?
Malunion (therefore close follow-up post closed reduction) Chapter 59 - Page 757
What is the last ossification center to fuse in the distal humerus?
Medial epicondyle (fuses 15-20 years) Medial Epicondyle Fractures in the Pediatric Population, Hilton P. Gottschalk, J Am Acad Orthop Surg April 2012 ; 20:223-232.;doi:10.5435/JAAOS-20-04-223 Chapter 61 - Page 787
Which is more common- elbow dislocations or fracture of the medial epicondyles in children?
Medial epicondyle fractures are more common (10-20 % of elbow fractures in children) Chapter 61 - Page 787 Medial Epicondyle Fractures in the Pediatric Population, Hilton P. Gottschalk, J Am Acad Orthop Surg April 2012 ; 20:223-232.;doi:10.5435/JAAOS-20-04-223
When performing a surgical dislocation of the hip, what is important to preserve?
Medial femoral circumflex artery and the short external rotators Surgical approach maintaining blood supply to the femoral head with trochanteric osteotomy Chapter 32 - Page 416
Female athletes with recurring stress fractures, history of amenorrhea, menstrual irregularities or eating disorders should undergo what type workup?
Metabolic bone workup Chapter 61- Page 792
Michael Todd Mazurek, M.D. 1968-2009
Michael Todd Mazurek, M.D. 1968-2009 This chapter's flashcards is dedicated to one of its 2 authors, Dr. Mazurek. Please read more about this dedicated orthopedic surgeon at : http://www.ota.org/about/In%20Memoriam_Dr.%20Mazurek.pdf
Periannualar solute transport occurs through what structures in the anulus fibrosis? What is the distribution from inner to outer anulus?
Micro-tubules Decrease from inner to outer anulus Chapter 3 - Page 29
What are the common patient characteristics in primary elbow osteoarthritis?
Middle-aged man who often performed manual labor Chapter 27 - Page 343
What is the ideal length of a transtibial amputation?
Midpoint of the tibia Allows for adequate muscle padding (Minimum level at junction of middle and proximal thirds, below flare of plateaus) Chapter 41 - Page 538
What is the most accurate test for measuring hip stability in CP patients?
Migration percentage: measure of the percent of the femoral head without acetabular coverage Monitor and measure hips until skeletal maturity (In cerebral palsy, the goal is to prevent hip dislocation) Migration is percentage = A/B x100 Chapter 63 - Page 814
What surgical intervention is indicated for adult acquired flatfoot stage IV?
Mild to moderate ankle arthritis: Reconstruct ankle ligaments to correct the valgus deformity i.e. deltoid ligament Severe ankle arthritis: 1. Arthroplasty 2. Ankle arthrodesis Adult-acquired Flatfoot Deformity • Jonathan T. Deland J Am Acad Orthop Surg July 2008 ; 16:399-406.
The best results with surgical dislocation are achieved in which patients?
Minimal OA and preserved labrum Chapter 32 - Page 416
Duplication of the zone of polarizing activity (Z.PA) results and what congenital anomaly?
Mirror image duplication of the limb Chapter 55 - Page 697
In periprosthetic total hip fractures, what is the most common error and management of femur fractures?
Misclassifying a Vancouver B2 facture as a B1 Vancouver Classification for Periprosthetic Fractures of the Femur Type A Pertrochanteric fracture AL Fracture of the lesser trochanter AG Fracture of the greater trochanter Type B Fracture around the femoral component B1 Femoral component well-fixed B2 Femoral component loose B3 Femoral component loose with severe loss of femoral bone stock Type C Fracture distal to the femoral component Chapter 32 - page 427
What is a common cause of failed ACL reconstruction?
Missed PLC injury Harner CD, et al, Biomechanical analysis of a posterior cruciate ligament reconstruction: Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med 2000; 28:32-39.
Which organelle is associated with apoptosis from endoplastic reticulum release of calcium following mechanical trauma?
Mitochondria Mitochondrial pores open allowing calcium to enter Mitochondria also releases superoxide radicals after impact injury (blocking the above processes diminishes chondrocyte apoptosis) Chapter 3 - Page 26
In a dynamic ultrasound of the hip, the head position is assessed in relationship to posterior wall of the acetabulum with what physical exam test?
Modified Barlow test A: Ultrasound of the child's dislocatable hip with modified Barlow maneuver (head posterior and superior to posterior wall) B.: Alpha and Beta angles Chapter 58 - Page 740
Current research into the relationship of slipped capital femoral epiphysis and femoral acetabular impingement is changing the surgical approach to unstable severely slipped epiphysis. What are two techniques for controlled reduction of severely slipped capital femoral epiphysis that may better protect the vascular supply?
Modified Dunn procedure. A, Illustration demonstrating the femoral neck presented out of the soft-tissue tube with controlled external rotation of the femur (arrows on the distal femur), careful leverage against the epiphysis, and additional freeing of the posterior soft-tissue attachments. The upper surface is rounded with a rongeur (arrowhead), and callus apposition (ie, posterior and medial callus on the neck) is resected with a straight osteotome (double arrow). B, One hand stabilizes the epiphysis while the other removes all debris and the remaining physis with a curet with the distal fragment externally rotated (arrow). AP C, and lateral D, supine radiographs of the left hip in a 12-year-old girl with a 10-week history of severe left thigh and knee pain. Examination elicited extreme discomfort on attempted passive motion of the hip. E, Intraoperative AP fluoroscopic image with the hip in abduction following transtrochanteric surgical hip dislocation and open reduction with threaded Kirschner wire (K-wire) fixation of the previously slipped epiphysis on the metaphysis. The trochanter was reduced and stabilized with three 3.5-mm cortical screws. F, AP standing radiograph of the left hip 7 months postoperatively. The threaded K-wires and cortical screws have been removed. The patient ambulates with normal gait and without hip pain, and left hip range of motion is near normal. Chapter 58 - Page 746
What is the surgical femoral reconstruction of choice when there is less than 4 cm of isthmus available for fixation?
Modular titanium tapered stem Modular titanium tapered stem Chapter 32 - Page 425
Which type of distal femur physeal fractures have a high risk of growth plate arrest?
More than 50% bone diameter displacement Chapter 59 - Page 754
What is the most common bacteria, less common, and rarest in epidural abscess formation?
Most Common: Staph aureus (MRSA should be considered with retained vascular and spinal implants) Less Common: Staph epidermidis Escherichia coli (urinary tract infections), Pseudomonas aeruginosa (intravenous drug abuse) Rare causes: Anaerobic bacteria Fundi Parasites Chapter 43 - Page 570
What are the most common, relatively frequent and, less frequent pathogens for postoperative spine surgery infections?
Most common: 1. Staph aureus-most common Relatively frequent: 1. Staph epidermidis 2.. MRSA Less frequent: 1. Gram-negative 2. Anaerobes Chapter 43 - Page 571
What is the etiology of hip dysplasia?
Multifactorial 1. Hip develops in approximately a seventh week gestation 2. Acetabulum grows in response to a concentrically reduced femoral head 3. Acetabular dysplasia develops in response to malpositioned femoral head in utero Chapter 58 - Page 739
Multifocal motor neuropathy is also an autoimmune demyelinating neuropathy. It is characterized by asymmetric weakness in the distribution of individual peripheral nerves. It is confused sometimes with amyotrophic lateral sclerosis (ALS). Clinically, how does multifocal motor neuropathy differentiate from ALS in regards to the weakness distribution?
Multifocal motor neuropathy: Asymmetrical weakness in distribution of peripheral nerves ALS: Weakness distribution in myotomes Multifocal motor neuropathy is much less common than ALS Chapter 19 - Page 232
In the ankylosed spine there are long lever arms and osteopenia. In those patients with anterior column gap what must be added to the anterior plating and structural bone graft to prevent nonunion?
Multilevel posterior segmental stabilization combined with decompression Extension injury in ankylosed patient with anteior gap and epidural hematoma Chapter 48 - Page 634
Metastatic disease is routinely evaluated by whole body scans with typical patterns of multifocal areas of increased uptake especially in the axial skeleton. What neoplasm is better detected by routine radiographs?
Multiple myeloma Multiple myeloma may have a negative whole-body scan Chapter 8 - Page 99
There are at least seven subtypes of Guillain-Barré syndrome. The most common is acute inflammatory demyelinating polyneuropathy. The immune response with this type is directed against what part of the nerve?
Myelin Gangliosides compounds (large quantities in peripheral nerves) has been considered as the target Davids, H. "Guillain-Barre Syndrome". Medscape Reference. Retrieved 3 Jan 2012. Chapter 19 - Page 232
How does the canal diameter vary along the spine and how does this affect vertebral osteomyelitis management?
Narrower in the cervical and thoracic spine, therefore higher risk for serious neurologic complications with epidural abscess. Chapter 43 - Page 565
What is the typical configuration and location of placement of uniplanar external fixator pins for treating tibial shaft fractures?
Near-far configuration on either side of the fracture along the anteromedial surface of the tibia Chapter 37 - Page 481
What is the most common position of the forearm in radioulnar synostosis?
Near-neutral therefore well tolerated and no surgery indicated Chapter 55 - Page 706
What percentage of medial epicondyle fractures are associated with elbow dislocation?
Nearly 50% of medial epicondyle fractures are associated with an elbow dislocation Chapter 61 - Page 787
Do individual biomarkers predict those patients with osteoarthritis?
No (Combinations of markers are more predictable for OA) CTX ratio with PINP predicts progression of OA Chapter 3 - Page 28
Currently, is there any study with significant evidence based medicine proving that screening and treatment are effective for vertebral artery injuries?
No 1.Transcranial Doppler: May identify clinical relevance flow disruption 2. Long-term study: Vertebral artery occlusion persistent beyond 26 months following injury. Chapter 48 - Page 636
Is a laminectomy indicated for patients with vertebral osteomyelitis? Why or why not?
No A laminectomy is contraindicated because it causes kyphosis Chapter 43 - Page 570
Should the wound in open fractures of the tibia be routinely closed primarily at the initial debridement?
No A repeat debridement in 48-72 hours should be done to reassess. Chapter 37 - Page 485
In meningomyelocele, is posterior fusion with instrumentation adequate for curve correction?
No Cohort study reveals that the combination of anterior and posterior spinal fusion with instrumentation is the best to maintain curve correction. Study compared 3 groups: 1. Posterior fusion with instrumentation 2. Posterior and anterior spinal fusion with posterior only instrumentation 3. Anterior and posterior spinal fusion and instrumentation Chapter 63 - Page 817
Does the addition of Hydroxyapatite to a femoral stem improve the radiographic outcomes after total hip arthroplasty?
No HA does not seem to affect the clinical or the radiographic outcomes. Chapter 32 - Page 422
In looking at the open mouth view and atlas fractures, if the combined lateral mass overhang does not meet the 7 mm or greater criteria does this indicate that there is no transverse atlantal ligament disruption?
No Recent study using MRI and CT shows that only 39% of atlas fractures with transverse atlantal ligament disruptions were demonstrated with routine X-rays only Chapter 48 - Page 625
Is frank recurrent dislocation seen with valgus instability?
No Secondary stabilizers (ie, radial head) often minimizes the severity of instability (ADLs put very little valgus load at elbow therefore symptoms are subtle) Chapter 27 - Page 346
Distal symmetrical of sensory polyneuropathy is the most common neuropathy of diabetics. It begins at the toes and then progresses over time up the legs as well as into the fingers and arms. This can lead to an increased risk of trauma, ulceration and Charcot changes. Does having neuropathy require a long history with the diagnosis of diabetes?
No Small fiber neuropathy phenotype is association with impaired glucose tolerance Fasting blood sugar between 110-125 mg/dL Glucose challenge (75 g)-2 hour post 140-199 mg/dL Chapter 19 - Page 231
Is acute steroid administration after spinal cord injury the standard of care?
No Steroid administration is simply a treatment option and much debate goes on about its use and efficacy Chapter 48 - Page 627
Has there been any benefit from containment surgical intervention performed after the initial or early fragmentation stage?
No Surgical options for containment during the initial and early fragmentation stage include femoral varus osteotomy, periacetabular osteotomy and shelf arthroplasty Chapter 58 - Page 746
Is a labeled WBC scan accurate with vertebral osteomyelitis?
No There is intense uptake of labeled WBC in normal bone marrow of vertebral bodies Chapter 8 - Pages 99
If AVN occurs it usually becomes apparent within the first year but may not present itself up to 8 years. Are there any studies that show restricted weight bearing prevents AVN after hip dislocation?
No Therefore, there should be consideration of weight bearing as tolerated immediately after reduction. Chapter 31 - Page 401
Are bone stimulators supported unanimously in the literature for treatment of acute fractures or nonunions of the tibial shaft?
No Chapter 37 - Page 485
How do double-row versus single-row rotator cuff repairs compare with recent prospective randomized studies?
No advantage with double row therefore single row fixation is adequate for smaller ( <3 cm) tears Double row may be better for larger tears (>3cm) Chapter 24 - Page 307
What is the null hypothesis?
No difference between the 2 groups being study Chapter 15 - Page 172
Can whole body scans differentiate between benign and malignant lesions?
No, both can have intense tracer uptake Chapter 8 - Page 100
Is there any current evidence to support the use of post op bracing for ACL reconstruction?
No, difference in re-tear rates brace or no brace Chapter 35 - Page 454
Is FDG-PET CT useful in detecting lung metastases?
No, especially less than 1 cm Chapter 8 - Page 101
After skeletal maturity, is there significant cell division of chondrocytes?
No, except for the circumstance of injury Chapter 3 - Page 25
Does the serum uric acid level help in the diagnosis of gout?
No, it can be normal or low during an acute gouty attack Chapter 18 - Page 220
Posterior lateral rotatory instability is associated with frank dislocation. Is posterior medial rotatory instability associated with frank dislocation?
No, only subluxation Chapter 27 - Page 346
Do all overhead athletes with valgus instability have an history of acute injury with a "pop" of the medial collateral ligament ?
No, some will just experience pain during throwing motion and loss of velocity and accuracy Chapter 27 - Page 346
Is cosmesis an acceptable indication for surgery according to the AOFAS?
No, the bunion must be symptomatic and failed nonsurgical treatment (shoe modification with soft leather upper with a high wide toe box) Chapter 40- Page 526
In treating pediatric femur fractures with bridge plate technique, non-weight bearing should continue until what point?
Non weight bearing until fracture callous is visible (on average 5 weeks after surgery) Chapter 57 - Page 734
What is the treatment for multidirectional shoulder instability?
Non- surgical first. Patient education Activity modification Physical therapy strengthening program Chapter 24 - Page 303
In a 2007 cohort study with primary shoulder dislocation and large (>5 mm) and displaced (>2 mm) anterior-inferior glenoid rim fractures, the patients were treated conservatively unless there was not a concentrically reduced joint. What was their recurrent dislocation rate?
None (after 5.6 years) Chapter 24 - Page 301
A mechanical study of comparing stiffness between locked and unlocked plates used in osteoporotic bone concluded that using a stable lock screw at the end of the plate had a greater difference in stiffness (plate-bone) compared to nonlocked screws. What therefore should be used in the "last hole" with osteoporotic bone?
Nonlocked screw Chapter 6 - Page 69
Standard X-rays of a elbow injury in a growing child should include anterior posterior, lateral and what view?
Oblique view to rule out minimally displaced lateral condyle fracture Chapter 53 - Page 676
What is the treatment choice in Legg-Calve-Perthes disease with a child younger than 8 years at onset and have a Group A or Group B hip?
Observe Favorable outcome unrelated treatment Chapter 58 - Page 746
Fixation must include how many cortices with bridge plate techniques for pediatric femur fractures?
Obtain fixation with 6 cortices above and with 6 cortices below fracture Bridge plate techniques demonstrating fixation with 6 cortices above and 6 cortices below Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 734 Chapter 57 - Page 734
Pain referred to the knee from hip OA is referred by what nerve?
Obturator Nerve Obturator nerve innervates the medial distal thigh and knee Chapter 32 - Page 413
What is the preferred surgical treatment for unstable craniocervical injuries?
Occipitocervical fusion to C2 or C3 using rigid segmental fixation and posterior decompression as necessary. A: Occiput-C1 distraction and occipital-cervical dissociation (arrow) B.: Postoperative occiput to C2 fusion with instrumentation including iliac crest allograft, morcellized autograft and bone graft extenders Chapter 48 - Page 630
How is an "odds ratio" different than relative risk?
Odds ratios are generally used to express approximate relative risk in retrospective study designs or when event rates are very low or the incidence (baseline risks) is unknown. Odds Ratio= (outcome divided by No outcome in experimental group) divided by (outcome divided by No outcome in the control group) Chapter 15 - Page 168
What is the most common cervical spine injury in patients older than 65?
Odontoid fractures More than 20% of all cervical spine trauma is estimated to occur in patients older than 65 Chapter 48 - Page 623
To minimize the risk of avascular necrosis, a subtrochanteric shortening femoral osteotomy is performed to gently reduce the hip. This has replaced preoperative traction and is used in children older than what age?
Older than 3 or 4 years Shortening subtrochanteric femoral osteotomy including rotational and valgus deformity correction Chapter 58 - Page 742
Morning stiffness greater than________ suggest inflammatory arthritis such as rheumatoid arthritis.
One hour Chapter 18 - Page 217
How does Fondaparinux (Arixtra) compare with an Enoxaparin (Lovenox)?
One study found that it was effective for decreasing VTE in patients undergoing major elective knee surgery, but, there was an increased risk of bleeding when compared to Enoxaparin (Lovenox). Chapter 12 - Page 138
With longer term follow-up, the rate of pseudarthrosis is higher. With long-term follow-up, the pseudarthrosis rate can be as high as 24% in adult scoliosis surgery. What percentage of pseudo-arthroses was detected at 2 years follow-up?
Only 25% Chapter 45 - Page 593
Level of evidence applies to which questions asked by a particular study?
Only the primary research question Chapter 14 - Page 158
What should one suspect in a child with a "stubbed toe injury"?
Open distal phalanx toe fracture with nail-bed injury (low threshold to washout in the OR) (Similar to Seymour fracture of the hand) Radiographs of the great toe of a 10-year-old child who presented late with pain and purulence after "stubbing" her toe and who had bleeding from her nail fold. Radiographs of the contralateral toe (A), and injured toe (B) demonstrate physeal widening and step-off (arrows). The treatment included nail plate removal, débridement, reduction, and fixation (C). This patient had an unrecognized open physeal fracture, which became secondarily infected. Chapter 59 - Page 759
What is the treatment for displaced tibial eminence fracture (Type III and IV)?
Open versus arthroscopic repair (sutures, wires and screws have been studied) Sutures cerclage with FiberWire better fixation strength compared to screw fixation Am J Sports MedMarch 2007 vol. 35 no. 3 404-410, Dr. Anne Kathleen Eggers Chapter 61 - Page 785
What is the classification of os acromiale based upon?
Ossification centers The acromial ossification centers comprising the acromial apophysis. BA = basiacromion, MS = mesoacromion, MT = meta-acromion, PA = preacromion J Am Acad Orthop Surg January 2006vol. 14 no. 112-19 Symptomatic Os Acromiale Christopher A. Kurtz Chapter 24 - Page 304
Third-generation ankle arthroplasty with 95% survival at 6 years was taken off the market for what reason?
Osteolysis Chapter 40 - Page 524
What is the most common complication following treatment for pediatric femoral neck fractures?
Osteonecrosis Chapter 57 - Page 729
What portion of the meniscus can heal?
Outer 25-30% (red-red zone) Chapter 35 - Page 459
What is little leaguer's shoulder?
Overuse syndrome of the proximal humeral physis seen in pitchers Exam may be subtle Chapter 61 - Page 788
What is the most common patient complaint with recurrent elbow instability?
Pain Chapter 27 - Page 345
What the most common complaint in vertebral osteomyelitis?
Pain in the affected region (90% of cases) Associated with paraspinal spasm Chapter 43 - Page 565
What is the typical presentation of amyotrophic lateral sclerosis (Lou Gehrig's disease)?
Painless muscle weakness and atrophy usually asymmetric involving one limb (onset) with distribution restricted to single nerve or nerve root Less common: Impaired speech, swallowing, head control and disordered breathing Photographs of the hand and tongue of a patient with ALS. A, Atrophy of the intrinsic muscles of the hand along with fasciculations and cramps are often the most common manifestation of ALS; these symptoms may be confused with cervical radiculopathy. B, Tongue atrophy and fasciculations are common in ALS and often help in making the diagnosis. (Reproduced with permission from Amato AA, Russell JA: Neuromuscular Disorders. New York,NY, McGraw-Hill, 2008.) Chapter 19 - Page 235
Name the type of randomized controlled trial that compares two groups that each receive a different treatment and follows them over time. Also, name a limitation of this design.
Parallel design Limitation is that a very large sample size may be required when increasing the number of groups or arms. Chapter 15 - Page 169
What is the treatment of choice with a complete ACL injury in a growing child with a Tanner scale 2?
Partial trans-physeal Different ACL reconstructions in respect to growth plates A: Trans-physeal, adult-type; B.: Transverse epiphyseal, physeal sparing; C.: Partial trans-epiphyseal; D.: Extra physeal or physeal sparing Lower Extremity Injuries in the Skeletally Immature Athlete, Joshua B. Frank, J Am Acad Orthop Surg June 2007 ; 15:356-366. Chapter 61 - Page 786
Core decompression for AVN of the hip is best suited for which symptomatic patients?
Patient with Ficat stage 1 and 2 disease (no crescent sign or collapse) FIcat classification Chapter 32 - Page 421
According to a long-term followup study of medial epicondyle fractures, what treatment have the best results for displacement between 5 and 15 mm?
Patients treated with casting did just as well compared to patient treated with ORIF Chapter 53 - Page 681
What is the typical position of the lower extremity when the hip is posteriorly dislocated?
Patients typically present with the lower extremity flexed, adducted, and internally rotated (when there are no other ipsilateral lower extremity fractures or dislocations). On x-ray the lesser trochanter is typically less visible when compared to the other side because of the internal rotation deformity. The femoral head may appear smaller on the injured side since it is closer to the x-ray cassette than the non-injured contra-lateral hip. Chapter 31 - Page 399
What is the role of semiconstrained total elbow arthroplasty in rheumatoid arthritis?
Patients with inflammatory changes with symptoms and dysfunction refractory to nonsurgical measures. Chapter 27 - Page 343
When is arthroscopic contracture release indicated to restore motion in patients with dysfunction?
Patients with mild contracture Chapter 27 - Page 344
What is the role of synovecomy either open or arthroscopic in patients with rheumatoid arthritis with less than 90° of flexion?
Patients with significant inflammatory component with well preserved bony structures. Chapter 27 - Page 343
Which rotator cuff tear classification is the most elaborate and helpful in determining treatment plans?
Patte Classification of Rotator Cuff Tears Extent of Tear Group I: Partial tears or full-substance tears < 1 cm in sagittal diameter at bony detachment a. Deep, partial tears b. Superficial tears c. Small, full-substance tears Group II: Full-substance tears of entire supraspinatus Group III: Full-substance tears involving more than one tendon Group IV: Massive tears with secondary osteoarthritis Topography of Tear in Sagittal Plane Segment 1: Subscapularis tear Segment 2: Coracohumeral ligament tear Segment 3: Isolated supraspinatus tear Segment 4: Tear of entire supraspinatus and one half of infraspinatus Segment 5: Tear of supraspinatus and infraspinatus Segment 6: Tear of subscapularis, supraspinatus, and infraspinatus Topography of Tear in Frontal Plane Stage 1: Proximal stump close to bony insertion Stage 2: Proximal stump at level of humeral head Stage 3: Proximal stump at level of glenoid Quality of Muscle 1. Minimal fatty streaking 2. Less fat than muscle 3. Equal fat and muscle 4. More fat than muscle State of the Biceps Tendon 1. Intact 2. Subluxated 3. Dislocated Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 305 Chapter 24 - Page 306
What is the appropriate treatment for femur shaft fractures in patients 6 months old and younger?
Pavlik harness Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 731 Chapter 57 - Page 731 Table 1
If the weight bearing line on an AP standing film transects an affected compartment, what should be done if considering a cartilage restoration procedure?
Perform a realignment procedure before or during the cartilage repair Chapter 35 - Page 460
After realigning and splinting limb with a high energy tibial fracture, what is the appropriate next step in evaluating a possible concomitant vascular injury?
Perform ankle-brachial indice (blood pressure taken above ankle versus brachial measurement) Chapter 37 - Page 479
What foot deformity is common in Friedreich's ataxia?
Pes Cavovarus Photo of posterior and side radiographic view of the foot of a boy with Friedreich ataxia and a cavovarus foot. On the posterior view his heel is in marked varus positioning. On the lateral view he has a high arch consistent with cavus deformity and with obvious clawing of the toes. Chapter 63 - Page 820
What four radiographic measurements are used to diagnose Hip dysplasia?
Photo displays the right side of an AP pelvic radiograph showing the radiographic measurements used for hip dysplasia. The dotted line denotes the anterior center edge angle. The solid white line denotes the Tönnis angle. The black line denotes the medial clear space. B, A false-profile view showing measurement of the anterior center edge angle (VCA) Chapter 32 - Page 418
What are frequently misdiagnosed as ankle sprains in children?
Physeal injuries of the distal tibia and fibula Chapter 59 - Page 757
In skeletally immature patients with ankle sprains what is more likely than an injury to the ligaments?
Physeal injuries of the distal tibia and fibula Chapter 61 - Page 787
What is the treatment of choice with a complete ACL injury in a growing child with a Tanner scale equal 0 or 1?
Physeal sparing ACL reconstruction Chapter 61 - Page 786
What is the most common complication that occurs from the use of external fixation of pediatric femoral shaft fractures?
Pin tract infections Chapter 57 - Page 734
What is one technique used to prevent implant failure in older patients?
Placement of cement into pedicles Chapter 45 - Page 593
In children 8 years or older, what fixation is indicated in a Monteggia fracture with a length unstable ulna fracture?
Plate fixation Chapter 53 - Pages 681-682
What are the results of repair of the lateral ulnar collateral ligament for recurrent posterior lateral instability?
Poor Reconstruction because of attenuation of the native ligament tissue. Chapter 27 - Page 346
What is the primary reason for undiagnosed cervicothoracic injuries?
Poor imaging at the transition zone on plain radiographs With the expanding use of CT scan, undiagnosed injuries should become less frequent Chapter 48 - Page 635
Children of any age with Group C. had what type of outcome with any treatment?
Poor outcome Lateral pillar classification Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 745 Chapter 58 - Page 746
Please review the CAT scan on the flip side of this flashcards and indicate if repair of this rotator cuff will have a positive outcome.
Poor outcome given grade 4 fat infiltration of supraspinatus Chapter 24 - Page 304
What is the consequence of treating a complete ACL injury in a young athlete non-surgically?
Poor outcome with increased risk of distal tears and chondral damage Chapter 61 - Page 786
What is the surgical approach of choice for C7-T1 injuries?
Posterior The anterior approach has limited access and poor biomechanical stability in the thoracic vertebral body Chapter 48 - Page 635
What is posterior ankle impingement syndrome?
Posterior ankle pain with forced flexion (typically with running downhill and dancing) Posterior Ankle Impingement Syndrome • Javier Maquirriain J Am Acad Orthop Surg October 2005; 13:365-371
Instrumentation increases the risk for infection. Which approach anterior or posterior has a higher risk of infection?
Posterior approach Chapter 43 - Page 570
Pipkin-type IV, the femoral head fractures associated with a posterior wall acetabular fracture therefore can be treated how?
Posterior approach (modified Kocher-Langenbeck approach) with digastric osteotomy Protects medial circumflex artery Chapter 31 - Page 401
Which approach, odontoid screw fixation or posterior C1-C2 arthrodesis has a higher healing rate for unstable Type II odontoid fracture with the least reliance on external immobilization?
Posterior arthrodesis with segmental instrumentation Segmental posterior arthrodesis for odontoid fracture Chapter 48 - Page 631
The Francis severity scale of hangman's fractures measures displacement and angulation from the posterior edge of the body of the axis measured from what bony landmark? This segment was unstable given what measurements?
Posterior edge of the body of the third vertebra Displacement greater than 3.5 mm and angulation greater than 11° Francis classification (JBJS Br 1981;63 (3): 313‐8).
What is the surgical approach for scoliosis in spinal muscular atrophy?
Posterior fusion and instrumentation to the pelvis Avoid anterior approach (not to encroach on the respiratory system) Spinal muscular atrophy with treatment for scoliosis, posterior fusion with segmental instrumentation to sacrum Chapter 63 - Page 819
What is the most common injury that leads to a femoral head fracture?
Posterior hip dislocation Chapter 31 - Page 401
What is the prevalence of posterior vs. anterior hip dislocations?
Posterior hip dislocations make up 90% of hips dislocations. Chapter 31 - Page 399
What is the prevalence of posterior vs. anterior hip dislocations? Chapter 31 - Hip Trauma
Posterior hip dislocations make up 90% of hips dislocations. They result from an axial load to the lower extremity with the hip positioned in flexion and adduction. Anterior dislocations make up 10% of hip dislocations and result from external rotation of an abducted hip. Chapter 31
What is the posterior wall sign?
Posterior wall sign: The posterior wall does not pass through the center of the head (Lack of posterior coverage). Crossover and prominent ischial indicate retroversion. Also note pistol deformity (circle) Chapter 32 - Page 415
What is femoraoacetabular impingement, FAI?
Prearthritic mechanism with proximal femur abuts the acetabulum with range of motion which can lead to cartilage degeneration and OA FAI Chapter 32 - Page 414
Subtrochanteric pediatric femur fractures are defined as within 10 percent of the total femoral length from the lesser trochanter. What should you suspect from a subtrochanteric femur fracture that results from a low energy injury?
Preexisting pathologic lesion Chapter 57 - Page 729
What hemoglobin levels are predictors of the need for transfusion in patients undergoing THA or TKA?
Preoperative Hemoglobin < 13g/dL = 4 times greater chance of allogenic blood transfusion than a preop Hb of 13-15 g/dl Preoperative Hemoglobin < 13g/dL = 15.3 times greater than a Hb of >15 g/dl Chapter 12 - Page 141
What is the primary indicator of clinical outcome after treatment for an epidural abscess?
Preoperative neurologic impairment (4-22% have permanent paralysis) Chapter 43 - Page 57
The motion achieved after total ankle replacement is similar to what?
Preoperative range of motion (but now it is pain free) Chapter 40 - Page 524
During what part of the menstrual cycle is the ACL at greatest risk?
Preovulatory phase (first half) Chapter 35 - Page 453
If closed reduction is unsuccessful for displaced and angulated radial neck fractures, ORIF is done through a lateral approach. What can be done to minimize the risk of avascular necrosis?
Preserve any soft tissue attachment at the fracture site Chapter 53 - Pages 682
What is the main function of the ACL?
Prevents pivot shift of knee Chapter 35 - Page 453
What is a prognostic study?
Prognostic study investigates the effect of a patient characteristic on the outcome of disease Chapter 14 - Page 159
Duchenne muscular dystrophy is the most common type. It is X-linked and invariably fatal. What is the motor weakness in Duchenne muscular dystrophy?
Progressive proximal motor weakness (loss of ambulation by the age of 10 years) Chapter 19 - Page 234
What part of the Coagulation pathway does the Protime (INR)? and Partial Thromboplastin Time evaluate?
Protime (PT, INR): Intrinsic and Common Partial Thromboplastin time (PTT): Extrinsic and Common Chapter 12 - Page 138
What is the treatment for femoral neck non union or delayed union?
Proximal Femoral Osteotomy for non-union of the femoral neck Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 730 Chapter 57 - Page 729
Spinal muscular atrophy is among the most lethal genetic childhood disorders within incidence of 1 in 6000 births and is autosomal recessive. What is the primary area of motor weakness with this disorder?
Proximal muscle weakness Chapter 63 - Page 819
In the chevron osteotomy (bunion surgery) the head is moved laterally and fixed. The plantar aspect of the osteotomy should be what to the joint capsule?
Proximal to the joint capsule to minimize risk of avascular necrosis Avascular necrosis following Chevron osteotomy Chapter 40 - Page 527
With Erb's palsy, there is favoring of the C6-7 internal rotators and adductor about the shoulder over the C5-6 external rotators and abductors. If untreated what can happen to the glenohumeral joint?
Pseudoglenoid on the posterior surface of the glenoid due to subluxation from the posterior pull Arthroscopic view of the left shoulder of a 12-year-old child with a pseudoglenoid showing a pointed humeral head (HH) articulating with the posterior aspect (POST) of the convex glenoid, separated from the anterior aspect (ANT) by a central ridge Chapter 55 - Page 710
What spondyloarthropathy includes skin plaques, pitted or onycholytic nails, chronic uveitis, distal interphalangeal joint involvement accompany arthritis (oligoarticular or polyarticular?
Psoriatic Arthritis "Pencil in Cup" X-Ray of Psoriatic Arthritis Chapter 18 - Page 219
The Salter osteotomy is redirection and hinges at what joint?
Pubic symphysis (Restores 25° lateral coverage and 10° of anterior coverage) A. = Dega osteotomy, B. = Salter innominate osteotomy, C. = Ganz periacetabular osteotomy Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 743 Chapter 58 - Page 743
Osteoid osteoma accounts for 12% of all benign bone tumors. What is the treatment of choice for persistently painful osteoid osteomas?
Radiofrequency ablation (RFA) as the treatment of choice, with an electrode placed through a biopsy needle (RFA heats up the abnormal tissue to 90°C for 4 minutes and produces cell death) CT images of RFA using multipronged radiofrequency needles within osteoid osteoma Chapter 8 - Page 102
What is a bone bridge procedure in transtibial amputations and it should be reserved for what patient population?
Radiograph showing a bone bridge procedure (from OKU 10) 1. Transtibial amputations can have a surgically produced bridge between tibia and fibula 2. Should be reserved for young patients with traumatic amputations (Not all evidence supports this procedure as leading to better function) Chapter 41 - Pages 538-539
What is the most common synostosis in the arm?
Radioulnar synostosis Chapter 55 - Page 706
It is easy to control known prognostic and confounding factors, what is the best way to control unknown prognostic and confounding factors?
Randomization Chapter 15 - Page 168
Which spondyloarthropathy is triggered by GU or GI infection?
Reactive Arthritis Chapter 18 - Page 219
What is the first thing that a surgeon should do when vascular compromise is suspected in a tibial shaft fracture?
Realign and splint the leg and reassess Chapter 37 - Page 479
In cerebral palsy, equinovarus foot deformity can result from overpull of the anterior or posterior tibialis muscles. As to which muscle to transfer has been difficult to predict either by exam gait analysis or elecromyography. Rebalance of both the anterior and posterior tibialis is needed in what percentage of feet?
Rebalance of both anterior and posterior tibialis is needed in 2/3 of feet. Lengthening or split of anterior and posterior tibialis is indicated for equinovarus foot deformities in flexible foot deformities only. Osteotomies including calcaneal osteotomies are considered for rigid deformities. Interferance screw for split anterior tibialis tendon transfer Chapter 63 - Page 816
What is the management of symptomatic, recurrent posterolateral rotatory instability?
Reconstruction of the LUCL complex, using either autograft or allograft. The ulnar tunnel is placed in the supinator crest creating and "Y." tunnel at humerus Chapter 27 - Page 346
What is the ideal operative technique for management of valgus instability?
Reconstruction with tendon graft (Primary repair is rarely used, with acute avulsion injury) Chapter 27 - Page 347
Which muscle tendon unit is injured with an apophyseal avulsion of the anterior inferior iliac spine?
Rectus Femoris Chapter 61 - Page 788
What deformity is at risk following tibia tubercle fractures in children?
Recurvatum secondary to growth arrest (less risk in the adolescent) Chapter 59 - Page 756
Metastatic lesions of the proximal femur are common. When concern exists as to whether a lytic lesion of the proximal femur may be a primary bone tumor; the most prudent course is to...?
Refer the patient to a musculoskeletal oncologist. Biopsy performed away from tertiary referral centers has a significant rate of error (20%) Chapter 31 - Page 406
What surgery is done to correct congenital trigger thumb?
Release of A1 pulley for trigger thumb Chapter 55 - Page 710
Children with meningomyelocele and bilateral hip dislocation very rarely show functional loss. What is the surgical procedure indicated for their hip flexion contractures?
Release of hip flexion contractures leaving hips dislocated Chapter 63 - Page 817
What is the name of bundles that make up the non-myelinating small-caliber C fibers?
Remak bundles Chapter 19 - Page 225
What is the Wilson test (tibial spine compression of lateral aspect of medial femoral condyle)?
Reproducing pain by internally rotating the tibia during extension of the knee between 90 and 30°. Pain reduced with tibial external rotation (Sensitivity) Chapter 61 - Page 791
How do you repair the posteromedial rotatory instability? Medial and lateral approach.
Requires medial and lateral approach i. Medial approach: fix the coronoid fragment ii. Lateral approach: repair the LCL complex Chapter 27 - Page 346
What is a Smith-Petersen osteotomy?
Resection of the posterior column except that pedicles remain Chapter 45 - Page 590
Recent studies have shown equal curve correction between combined anterior release and posterior instrumentation fusion compared to all posterior approach with posterior instrumentation, fusion and what?
Resection osteotomies (done through posterior incision) 1. No direct comparison yet between anterior approach morbidity compared to posterior osteotomies morbidity 2. Anterior releases may not be necessary? Chapter 45 - Page 588
What are two treatments for little leaguer's shoulder?
Rest and until the symptoms resolve Gradual return to play Appropriate pitch counts are available at Little League Baseball and American Orthopaedic Society for Sports Medicine. (http//:www.sportsmed.org/tabs/resources/youthbaseballdetails.aspx?DID=231). Figure shows an AP radiograph of both shoulders in an adolescent baseball pitcher demonstrates right proximal humeral epiphyseolysis . Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 789 Chapter 61 - Page 789
Most stress fractures of the femoral neck are compression fractures of the inferior aspect. What treatment is recommended for this femoral neck stress fractures?
Restricted weight bearing. Fractures that involve the superior femoral neck (tension side) and complete fractures require internal fixation. Chapter 31 - Page 40
Describe Batson's venous theory of vertebral osteomyelitis.
Retrograde flow from the pelvic venous plexus allows for bacteria entry into the perivertebral venous system Paravertebral venous plexus Chapter 43 - Page 565
What is considered a Level 3 therapeutic study?
Retrospective comparative study and case-controlled study Chapter 14 - Page 159
What is a case controlled study?
Retrospective study where in the comparison of one group of patients who have a particular outcome with another group of patients who do not have the outcome of interest, based on characteristics (risk factors) plausibly associated with the outcome of interest. Chapter 14 - Page 159
There is a high rate of surgical complications with adult neuromuscular scoliosis surgery. What is the rate of revision surgery and infection rate with Parkinson's disease?
Revision rate = 86% Infection rate = 14% Chapter 45 - Page 592
What biologic combined with allograft can be used for osseous defect with open and closed tibial shaft fractures? This combination had results similar to autograft.
RhBMP-2 Chapter 37 - Page 487
What does the anterior impingement sign indicate?
Rim and labral pathology Chapter 32 - Page 414
Infected nonunion of the tibial shaft, should be treated with what stabilization?
Ring Ilizarov (Bone transport) Chapter 37 - Page 487
With inferior instability, the two sulcus signs indicate a injury to what anatomic part?
Rotator interval injury Rotator interval Chapter 24 - Page 303
What is the name of the type of conductance that occurs in myelinating neurons at the nodes of Ranvier with depolarization of sodium channel?
Saltatory conductance Arrival of the action potential-potassium channels open with potassium exiting and sodium channels open allowing sodium to enter the cell-intracellular more positive-polarity increased-sodium diffusion out of cell to repolarize Chapter 19 - Page 225
What is the most common fracture pattern for pediatric proximal humerus fractures?
Salter-Harris type II pattern with the distal shaft fragment displaced through the thinner anterior humeral periosteal sleeve Chapter 53 - Page 676
The evaluation and treatment of a hypoplastic thumb depends on the stability of the carpometacarpal joint. What procedure should be done with a stable CMC joint?
Salvage procedure with Z-plasty skin flap, ligament reconstruction and tendon transfers. Chapter 55 - Pages 700-701
What is the moving valgus stress test?
Same as milking maneuver, except elbow is taken through range of motion. Pain between 70-120 is positive. Chapter 27 - Page 346
There are special calculators to determine the appropriate sample size, including on the Internet. What are the three usual variable numbers that go into this calculation and name three other factors.
Sample Factor Capsulation (usual settings) 1. Type I error (alpha error) = 0.05 2.Type II error (beta error) = 0.2 3. Power = 0.8 Other Factors 1. Dropout rate = 80% followup would be good 2. Potential effect size = from literature or pilot trial 3. Clinically significant effect size = from literature or survey data Chapter 15 - Page 173
What are structures at risk with medial percutaneous plating?
Saphenous vein and nerve Chapter 37 - Page 481
What cell is mechanically sensitive and plays the major role in compressive neuropathies?
Schwann cells-demyelination and remyelination cell (Sensitive to shear forces with expression of specific surface adhesion proteins are altered in response to hydrostatic pressure) Chapter 19 - Page 229
What is the main risk of surgical correction of knee flexion contracture in CP patients?
Sciatic nerve stretch injury 9% Reduce risk by immediate flexing knee if there is post op foot pain Chapter 63 - Page 814
Which metatarsal presents most common as a stress fracture in adolescent athletes?
Second metatarsal Chapter 59 - Page 759
For osteosynthetic constructs, excessive stiffness can suppress what kind of bone healing?
Secondary bone healing Chapter 6 - Page 68
What results from incomplete lesions of peripheral nerves limited to myelin sheath?
Segmental demyelination Photo shows schematic of the peripheral nerve. Chapter 19 - Page 228
What is the standard treatment of scoliosis with muscular dystrophy?
Segmental instrumentation to the pelvis Segmental pedicle screw with extension into pelvis for muscular dystrophy, able to sit up straight Chapter 63 - Page 818
What is the sensitivity and specificity of osteomyelitis using a labeled WBC scan?
Sensitivity and specificity is between 83% and 89% Chapter 8 - Pages 99
What are the indications for total shoulder replacement in chronic posterior shoulder dislocations?
Significant glenoid arthritis Chapter 24 - Page 303
Hip dislocations may be simple (not associated with a fracture) or complex fracture-dislocation. What percentage of simple hip dislocations and complex fracture-dislocations develop posttraumatic arthritis? Posttraumatic arthritis is the most common complication.
Simple: Up to 26% More complex Fracture-Dislocations: Up to 90% (Most dislocations are in younger patients therefore above results are very concerning) Chapter 31 - Page 399
Why can patella fractures in children be easily missed?
Sleeve fractures largely consist of chondral fragments which are not easily visible on radiographs. Chapter 59 - Page 755
What fixation device should be used for the stabilization of a high Pauwell's angle femoral neck fracture? Pauwell's classification is typically used for hi energy fractures in young patients.
Sliding hip screw or fixed angle device such as a blade plate be used. Femoral neck fractures in young adults tend to have a more vertical fracture line.More vertical fractures are subjected to higher shear forces and therefore cannulated screws did not work Chapter 31 - Page 404
What is the range of clincial findings in central deficiency?
Slightly shortened middle finger to only one ulnar digit. Chapter 55 - Pages 700-701
The density of trabecular bone determines its stiffness and strength. This density can vary from 0.1 g/mL to 1 g/mL (1 order of magnitude). Stiffness can vary 3 orders of magnitude. What is the clinical significance?
Small change in bone density from osteoporosis can significantly change the bone stiffness and strength and result in a fracture. Chapter 6 - Page 61
What are the indications for non-surgical treatment of avascular necrosis?
Small lesions (less than 10%), pre-collapse and asymptomatic (Protected weightbearing with significantly sized lesions >80% failure rate) (Lipid-lowering medication and biphosphonates-currently being study given some promising results)
Children older than 18 months with a dislocated hip require open reduction. What is the most commonly used and best approach? What are three advantages?
Smith-Petersen approach (separate adductor tenotomy incision) 1. Preserved medial femoral circumflex vessels 2. Allows for capsulorrhaphy 3. Allows for pelvic osteotomy Chapter 58 - Page 742
What surgical procedures are indicated for symptomatic mild bunion deformity?
Soft tissue procedure: Modified Mcbride procedure Distal osteotomy Chevron Modified Mitchell Modified Mitchell osteotomy Chapter 40- Page 526
What is the surgical treatment for various OCD lesions?
Stable lesions: Drilling to subchondral bone to promote healing (arthroscopic transarticular drilling) Unstable and hinged: If fixable-arthroscopic or open reduction and internal fixation If not fixable-OATS Unstable and completely displaced- OATS Chapter 61 - Page 792
What are the four stages of the Larsen classification for the rheumatoid elbow?
Stage 1. Normal architecture and osteoporosis. Synovitis is present. Stage 2. Joint space narrowing and intact joint architecture. Synovitis is present. Stage 3. Alteration of joint architecture. Stage 4. Gross joint destruction and minimal synovitis. Chapter 27 - Page 344
Adult acquired flatfoot is usually the result of posterior tibial insufficiency with a spectrum of tendon involvement and can result in a fixed deformity. What are the four stages?
Stage I: Early degeneration of the tendon with peritendinitis symptoms (pain) Stage II: Passively correctable deformity Stage IIA: Less than 30% of talar head uncovered (standing AP radiograph) Stage IIB: Greater than 30% of talar head uncovered (standing AP radiograph) Stage III: Fixed valgus hindfoot deformity Stage IV: Foot and ankle valgus deformity Stage IV adult acquired flatfoot Chapter 40 - Page 527
What are the characteristics of late stages of posterior tibial tendon dysfunction (i.e., Stage II and IV)?
Stage III: Fixed valgus deformity of the hindfoot Stage IV: Fixed valgus deformity of the ankle joint Chapter 40 - Page 527
What is a meta-analysis?
Statistical method of combining the data provided by systematic reviews Chapter 14 - Page 159
What are two major complications reported with impaction grafting of the femur during revision hip surgery?
Stem subsidence Intra op or early post op periprosthetic fracture (More commonly used in Europe, and infrequently in US) Chapter 32 - Page 425
The stress strain curves (E modulus) of a particular material has a steeper slope or larger number. Does this indicate that the material is stiffer or more elastic?
Stiffer Stress-strain curves reflect the properties of representative materials in compression tests. The slope of the initial linear region of curves (continuous lines) represents stiffness (E = tensile strain/tensile strength). Steeper slopes represent stiffer materials. Yield points indicate limits of the elastic "working" region. Brittle materials such as cortical bone fail abruptly, whereby the yield point coincides withfailure. PMMA = polymethylmethacrylate. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 61 Chapter 6 - Page 61
What should the surgeon do if a patient's neurologic condition deteriorates during reduction efforts of a cervical spine fracture dislocation?
Stop the reduction and obtain an MRI of the cervical spine Chapter 48 - Page 627
Sample size for surgical randomized trials are smaller (compared to medical studies) and can lead to imbalance by chance. For example using a trauma center and a community hospital to study a new tibial plate. The trauma center will have a higher percentage of open fractures and high energy fractures. What can be done to balance the prognostic factors in this study?
Stratify randomization Stratify first into groups (i.e. open fracture) then randomized Gray people equals open fractures and high energy in our example Chapter 15 - Page 169
To define stiffness, the load is expressed as stress (stress = load divided by area the load is acting on). The compression of the cube can be expressed in terms of strain. What is definition of stiffness?
Stress/strain (stress divided by strain) Chapter 6 - Page 59
Why is it that pediatric dislocations have a higher rate of redislocation?
Stretches the capsule more than adult dislocations Chapter 61 - Page 788
What finding confirms the diagnosis of gouty arthritis?
Strongly birefringent needle shaped monosodium urate crystals Chapter 18 - Page 220
How does level of evidence affect orthopaedic practice?
Studies of higher level of evidence have greater methodologic safeguards against bias, they may provide better information to guide physicians in their care of patients. Chapter 14 - Page 161
What is subgroup analysis and subgroup affect?
Subgroup analysis: Different treatment effects based on characteristics of patients (old or young) or different aspects of treatment (reamed versus non-reamed nail) Subgroup effect: Results are different by looking at a subgroup Chapter 15 - Page 171
What is appropriate treatment for femur shaft fractures in patients greater than 11 years and fracture very proximal or distal?
Submuscular bridge plate Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 731 Chapter 57 - Page 731
What are the results of acute repair of tears with acute instability of Lateral ulnar collateral ligament complex?
Successful Can be done open or arthroscopically Chapter 27 - Page 346
In adult scoliosis with stenosis, which is more effective: nonsurgical treatment or lumbar decompression?
Surgical decompression Chapter 45 - Page 588
What is the typical treatment for epidural abscess?
Surgical decompression followed by tailored antibiotic therapy Chapter 43 - Page 570
What is the surgical gold standard for treatment of FAI?
Surgical dislocation with good to excellent results reported 80 to 90% The indications for arthroscopy for treatment of FAI continues to evolve (patient selection important with hip dislocation and arthroscopic approaches Chapter 32 - Page 416
What is the preferred treatment plan for most postoperative wound infection?
Surgical irrigation and debridement and antibiotic therapy Chapter 43 - Page 571
Synovial white cell count is the best diagnostic study for infection preoperatively or intra-operatively. Above what cut off values is infection diagnosed?
Synovial WBC greater than: 3000/mm3 if ESR and CRP both elevated 9000/mm3 if ESR and CRP only one elevated PMN >80% also diagnostic (Frozen Section-pathologist can be variable and sampling error; Gram stain-not helpful) Chapter 32 - Page 426
What are clinical practice guidelines?
Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Chapter 14 - Page 161
The cell bodies of the primary autonomic neurons and tracts are in the intermediolateral column of the dark matter of the cord. The sympathetic nerve bodies are located at which levels?
T1-L1 Green area: intermediolateral column (autonomic tracts and nucleus) Chapter 19 - Page 228
With MRI arthrography, a labral tear of the hip is best diagnosed with a high intensity on what view?
T2-weighted MRI T2-weighted MRI with gadolinium T2-weighted MRI with gadolinium, arrow indicates anterior superior labral tear with increased signal intensity that extends to articular surface Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 416 Chapter 32 - Page 416
What is the Tanner Scale and what is its impact on ACL reconstruction in the skeletally immature patient?
Tanner Scale: Determines sexual maturity therefore remaining growth in the distal femoral and proximal tibial physes Lower Extremity Injuries in the Skeletally Immature Athlete, Joshua B. Frank, J Am Acad Orthop Surg June 2007 ; 15:356-366. Chapter 61 - Page 786
How does a study use appropriate randomization technique?
Team does not know the allocation of the next study participant before the patient receives his/her treatment allocation Chapter 14 - Page 159
What is the most common cause of Trendelenburg gait after anterior lateral approach for hip arthroplasty?
Tear of the gluteus medius (Superior gluteal nerve injury-also possible) JAAOS July 2011 vol. 19 no. 7 385-391
How should partial rotator cuff tear be treated?
Tears that are at least 50% (6mm) thick are repaired. (Over time these tears may progress to full thickness) Chapter 24 - Page 307
Which muscle tendon unit is injured with an apophyseal avulsion of the anterior superior iliac spine?
Tensor fascia lata Chapter 61 - Page 788
Stiffness of a solid cylinder is related to diameter to what power?
The 4th power Illustration showing the influence of cross-sectional geometry on bending stiffness of basic structures. For example, increasing the outer diameter of a cylindrical structure from 10 mm to 12 mm while retaining a wall thickness of 2mm increases bending stiffness (I) by 82%. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 62 Chapter 6 - Page 61
What is the Eismont-Starr variant of hangman's fracture and why is important?
The Eismont-Starr is an atypical hangman's fracture because the fracture line is in the vertebral body and not the pars. There is a 33% risk of spinal cord injury. Spine (Phila Pa 1976). 1993 Oct 15;18(14):1954-7. Atypical hangman's fractures. Starr JK, Eismont FJ.
What is the origin and insertion of the MPFL (medial patellofemoral ligament)?
The MPFL originates from the adductor tubercle and attaches to the upper 2/3rds of the patellar border Medial patellofemoral ligament Chapter 61 - Page 784
The presence or absence of function at what level has the most significant prognostic implications in spinal cord injury patients?
The Rectal Exam (S4-S5) 1. Perianal sensation with light touch and pinprick 2. Voluntary anal contraction 3. Determines whether complete or incomplete injury (sacral sparing) Chapter 44 - Page 574
Which biological signaling pathway is strongly associated with OA?
The Wnt/Beta-catenin pathway 1. Wnt is a network of signaling proteins for cell to cell communication 2. Without Wnt, Beta-catenin is degraded in the cytoplasm before it can get into the nucleus 3. With Wnt protein binds the Fizzled receptor (on the cell membrane)- prevents the degradation of Beta-catenin which builds up 4. Beta-catenin enters nucleus 5. Now gene transcription can occur 6. Therefore Wnt induced signaling upregulates matrix protease(loss of cartilage homeostasis = OA) 7. Inactivating gene mutation for "frizzled" related protein-3 receptor leads to OA 9. Mechanical stress of chondrocytes leads to Beta-catenin activation with over expression leading to OA 1.APC-GSK-CK1 complex degrades Beta-catenin by phosphorylation, Beta-catenin therefore does not enter nucleus 2.Wnt ligand binds Frizzled receptor inhibits the APC-GSK-CK1 degradation complex 3. Increases Beta-catenin in the cytoplasm translocate into the nucleus 4.Beta-catenin interaction with resident lymphoid enhancer factor/T-cell (TCF/LEF transcription factors) activating Wnt target gene 5. Increased matrix catabolic enzymes Chapter 3 - Page 25
20% of Inflammatory bowel disease patients particularly Crohn's Disease will either have either a peripheral arthritis of the lower extremities (80%) or spondylitis similar to A.S. (20%). The activity of the peripheral arthritis correlates with what?
The activity of the intestinal disease (Activity of the axial arthritis is independent of the intestinal disease) Chapter 18 - Page 219
Needle biopsies of primary bone tumors should be discussed first with an orthopedic tumor specialist. Why is this important?
The approach and needle route may compromise any malignant tumor surgery because of "seeding" other compartments (worsening the stage) or incision planning (must excise path) Chapter 8 - Page 102
What MRI pattern is seen with a lateral patellar dislocation?
The contusions/osteochondral injuries occur on the: 1. Medial facet of the patella 2. Distal lateral trochlea Bone contusion following dislocation at medial facet and lateral femoral condyle Chapter 61 - Page 784
If one uses intra-compartmental pressures to diagnose compartment syndrome, how should the calculation for diagnoses be done?
The delta p should be used, diastolic pressure minus the intra-compartmental pressure. Delta p below 30 should be deemed diagnostic. Chapter 37 - Page 479
Which tendon glides next to an os trigonum, often producing pain during activities?
The flexor hallucis longus tendon (FHL slides into a groove at the posterior medial talus with maximum plantar flexion) Chapter 40 - Page 525
On which radiographic view is the "crescent sign" best appreciated?
The frog lateral view Figure A, The crescent sign as depicted on the frog lateral view (arrows). Figure B, Intraoperative specimen of the same patient undergoing THA with evidence of subchondral collapse and a large necrotic segment. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 420
During revision of the acetabular component, the integrity of which bony structure is primarily relied upon for successful reconstruction?
The posterior column Chapter 32- Page 423
What does the P value represent?
The probability of committing an alpha error (type I error): False-positive P value is the probability of finding a difference between the 2 groups when truly there is no difference. Chapter 15 - Page 172
What does the beta represent?
The probability of committing an type II or beta error (type II error): False-negative Beta is related to the power of the trial i.e. the probability of not finding a difference in the 2 groups when truly there is a difference Chapter 15 - Page 172
How to determine that there is a transphyseal humeral fracture versus lateral condyle fracture or elbow dislocation?
The relationship of the radial head and capitellum is intact Chapter 53 - Page 68
How do the results of post-traumatic subtalar joint arthritis differ with operatively treated vs nonoperatively treated calcaneus fractures?
The results of subtalar fusion are better in patients with surgically repaired calcaneal fractures compared to those initially treated nonsurgically. Chapter 40 - Page 525
What determines the end of spinal shock?
The return of the bulbocavernosus reflex Chapter 44 - Page 573
Stress fractures of the femoral neck can be on the tension or compression side. Which is more likely to progress and therefore require early surgical intervention?
The risk of fracture progression is higher for tension side than compression side fractures. Therefore there should be a lower threshold for prophylactic fixation on tensile side fractures. Photos show, A--Bone scan showing stress fracture in the superior femoral neck region. B--Screw fixation for a superior femoral neck stress fracture. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 792 Chapter 61- Page 792
The modulus of elasticity describes the "working" region of the material. What happens when the deforming force is removed?
There is complete reversal of deformation after load is removed Chapter 6 - Page 60
Based on the AACP guidelines what patient populations can be prophylaxed with LMWH?
There is grade 1A data when LMWH is used for VTE prophylaxis for patients undergoing THA, TKA, and hip fracture surgery. Heparin increases activity of Antithrombin III (ATIII) which degrades factors IIa, IXa, Xa, XIa and XIIa therefore PTT Chapter 12 - Page 138
What is the current treatment recommendation for a Garden type I or II femoral neck fracture in an elderly patient? The Garden Classification is typically used with low energy fractures seen in the elderly.
These patterns are typically stabilized using 3 cannulated screws. Garden type I fractures are valgus impacted patterns. Garden type II are complete but non-displaced fractures. Photo shows Garden classification of neck fractures. Chapter 31 - Page 404
How do botulin toxin injections work on spasticity?
They cause paralysis by blocking the acetylcholine release of the neuromuscular junction Botulism interferes with the release of acetylcholine by preventing vesicles fusing with cell membrane of nerve Chapter 63 - Page 812
What is the pathogen of Lyme Disease?
Tick transmitted spirochete (Borrelia burgdorferi) Chapter 19 - Page 234
Why is it that when testing motor nerves, the motor nerve must be stimulated at two different locations along its path?
To eliminate the delay at the neuromuscular junction and only measure the latency of the nerve Motor latencies are measured both by measuring the distance between the two stimulating electrode sites and difference in the latencies. Motor nerve conductance of median nerve, NB multiple sites Chapter 19 - Page 229
For high demand athlete, what would be the rationale for ORIF of medial epicondyle displaced fracture?
To prevent instability Chapter 53 - Page 681
What is the best treatment for Wagner grade 1 and 2 diabetic foot ulcers?
Total contact casting Chapter 40 - Page 530
What is the operative treatment of choice for older and more sedentary patients with elbow osteoarthritis?
Total elbow arthroplasty Chapter 27 - Page 343
What is the best treatment option for symptomatic patients with advanced osteonecrosis?
Total hip arthroplasty Better results than: 1. Total Hip Resurfacing (Total hip resurfacing did better than hemi-resurfacing) 2. Hemiarthroplasty (only 48% satisfactory results) 3. Hemi-resurfacing Chapter 32 - Page 421
Fibrin sealant (topical) has proven to be effective and safe in decreasing blood drainage and maintaining higher hemoglobin levels. In what surgical situation should it be considered the most?
Total knee replacement particularly with inflamed synovium Chapter 12 - Page 142
Are any intravenous antifibrinolytic drugs effective in limiting blood loss during THA?
Tranexamic diminished postoperative and total blood loss but not intraoperative blood loss Chapter 12 - Page 142
What newer implant has shown equivalent results to smooth K-wires for metaphyseal fractures?
Transepiphyseal bioabsorbable implants. Chapter 59 - Page 757
In the absence of a fixed plantar flexion contracture, what is the surgical treatment for a foot drop from neurologic injury or disease?
Transfer of posterior tibial tendon through the interosseus membrane to the midfoot Chapter 40- Page 531
SDA (screw displacement axes) analysis of the knee during running showed how much translation and up to what change in axis inclination during the flexion cycle?
Translation up to 20 mm Up to 15° of change of inclination of the instantaneous axis Illustration showing a characterization of joints. A, A series of SDAs obtained from incremental joint motion represents the location and dispersion of rotation axes over the elbow range of motion. The smaller the axes dispersion, the closer the joint resembles an ideal hinge joint. The angles between the average SDA and the ulnar and humeral shaft axes are denoted by ß1 and ß2, respectively. B, Graph showing joint laxity of the elbow, represented by the permissible varus-valgus rotation from a neutral motion path in response to defined varus-valgus loads over the flexion range of motion. (Reproduced with permission from Bottlang M, Madey SM, Steyers CM, Marsh JL, Brown TD: Assessment of elbow joint kinematics in passive motion by electromagnetic motion tracking. J Orthop Res 2000;18:197-198.) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 65 Chapter 6 - Page 65
Joint dynamics are measured in 6° of freedom with one bone fixed. Give the three translation and three rotational parameters
Translation: X = medial-lateral Y = anterior-posterior Z = proximal-distal Rotation: Alpha = flexion-extension Beta = varus-valgus Gamma = internal-external Chapter 6 - Page 65
Symbrachydactyly is usually not bilateral What is the range of clinical findings of Symbrachydactyly?
Transverse deficiency above the elbow to mild hypoplasia of the hand. Chapter 55 - Page 702
The Pitkin IV type requires a digastric osteotomy. What is a more common name for this osteotomy?
Trochanteric slide Chapter 31 - Page 401
Removal of the apical ectodermal ridge (AER) results in what congenital anomaly?
Truncated limb or Transverse deficiency (reversible by applying fibroblast growth factors to limb bud) Chapter 55 - Page 697
What is the definition of a force couple?
Two equal but opposite directed forces which are applied simultaneously on the opposite sides of the axis of rotation resulting in torque (Translational forces and linear motion cancel out) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 301 Chapter 24 - Page 300
What is the gold standard for treatment of a chronically infected total joint replacement?
Two-stage revision: A. Removal of the implant and placement of an antibiotic loaded cement spacer B. Systemic antibiotics for 6 weeks C. Off antibiotics for an additional 2-4 weeks D. Reimplantation of an implant if the infection has been resolved. Chapter 32 - Page 427
The lateral pillar classification is used to classify the fragmentation stage using the first AP X-ray during fragmentation. What are the four types?
Type A : lateral third of epiphysis height = contralateral hip Type B: Lateral third of epiphysis collapsed >50% Type C: Lateral third of epiphysis collapsed but height <50% Type B/C borderline: Lateral third of epiphysis collapsed and thin poorly ossified but height = 50% Lateral pillar classification Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 745 Chapter 58 - Page 745
What are the usual treatment approaches for each type of atlas fractures? NB stability is determined by intact transverse atlantal
Type I (Avulsion Fractures): soft collar 4-6 weeks Type II (Posterior Arch): cervical collar 10-12 weeks hi union rate Type III ( Anterior Arch): closed reduction with slight flexion then halo or C1-C2 fusion Type IV (Lateral Mass) and Type V (Burst): 1. Minimally displaced- halo 3 months 2. Displaced or unstable- reduced by traction (several weeks) then halo or C1-C2 fusion 3. Late Displacement, C1 non-union or late instability- occiput to C2 fusion C1-C2 fusion with trans-articular screws Upper Cervical Spine Injuries; R. Sean Jackson et al. J Am Acad Orthop Surg July/August 2002; 10:271-280.
A new classification for lateral condyle fractures is based on displacement and whether the articular cartilage is intact on arthrogram. List three classifications of lateral humeral condyle fractures.
Type I - < 2 mm displacement (indicates intact articular surface) Type II - > 2 mm displacement with intact articular cartilage (post arthrogram) Type III - > 2 mm displacement with incongruent articular cartilage (post arthrogram) Chapter 53 - Page 680
What is the Neer-Horowitz classification of proximal humerus fractures?
Type I - minimally displaced Type II - displacement < 1/3 humeral shaft width Type III - displacement between 1/3 & 2/3 humeral shaft width Type IV - displacement > 2/3 shaft width Chapter 53 - Page 676
What is the Gartland classification of supracondylar humerus fractures?
Type I - minimally displaced Type II - incomplete unicortical fracture with > 3 mm displacement Type III - complete displacement with intact periosteal sleeve on the side of the distal fragment angulation Type IV - complete displacement without intact periosteal sleeve (unstable) Chapter 53 - Page 677
What are three classifications of odontoid fractures using the Anderson-d'Alonzo classification? What are the risks of nonunion with each type?
Type I: Avulsion fracture of the tip, above TAL therefore stable (rare) Type II: Base, very unstable, 10-77% nonunion rate Type III: Moderately unstable, low non-union rate Upper Cervical Spine Injuries R. Sean Jackson, J Am Acad Orthop Surg July/August 2002;10:271-280.
What treatment is indicated for odontoid fractures?
Type I: Cervical orthosis 6-8 weeks (as part of unstable occipitocervical dislocation then occiput-C2 fusion) Type II: Nondisplaced or easily anatomically reduced: Halo vest x3 months Displaced: 1. Halo-vest 2. Odontoid screw ORIF 3. C1-C2 arthrodesis Type III: Halo vest x3 months Odontoid screw for Type II odontoid fracture Upper Cervical Spine Injuries; R. Sean Jackson et al. J Am Acad Orthop Surg July/August 2002;10:271-280.
Occipital condyle fractures are classified in three different Types (Anderson-Montesano), what is the mechanism of each type and what is the stability of that type?
Type I: Impaction, stable Type II: Shear injury extending into school, stable Type III: Avulsion injury of alar ligament, highly unstable i.e. craniocervical disruption a,c,e = coronal; b,c,f = transverse (assessing foramen magnum encroachment) Type I:a,b Impaction condyle; Type II:c,d basilar skull fracture; Type III:e,f avulsion type with encroachment into the foramen magnum Chapter 48 - Page 625
The Levine classification for atlas fractures divides the fractures into five groups, What are the five Types, their mechanism of injury and stability?
Type I: Isolated bony apophysis fracture (extra-articular fracture of transverse process), mechanism = ?, stable Type II: Isolated posterior arch fracture, hyperextension, stable Type III Isolated anterior arch fracture, hyperextension with dens force through anterior arch, unstable if displaced Type IV: Lateral mass fracture, lateral axial compression, unstable Type V: Burst Fracture (Jefferson fracture), three or more fragments, axial load, Stability depends on displacement and integrity of transverse atlantal ligament Chapter 48 - Page 625 A: I, Avulsion; B: II, Anterior Ring; C: III, Posterior Ring; D: IV, Lateral Mass; E: V, Burst
The (Harborview) craniocervical injury classification has simplified traumatic disruption into three types. What are the three types and their stability?
Type I: Isolated injury include stable unilateral injuries like Type III occipital condyle injuries or isolated alar ligament tear; stable nonsurgical Type II: Ambiguous, disruption with borderline radiograph screening Type III: Complete disruption of all interconnecting ligaments A.: Posterior view B.: Sagittal view, C.: Anterior view of the atlanto-axial articulation AP = apical ligament, TR = transverse atlantal ligament, AL= alar ligament, AC = accessory ligament Chapter 48 - Page 625
With total hip revision, describe three types of acetabular defects as per Paposky.
Type I: No defect Type II <3 cm of proximal migration IIa migration superior medially IIb migration superior laterally and loss of acetabular rim IIc defect associated with protrusion medially past Kohler line(ilioischial line) Type III >3 cm migration of acetabular component IIIa damage to remaining acetabular rim superiorly and anteriorly with intact posterior column ("up and out") IIIb large defect of medial wall (disruption of Kohler line) with ischial osteolysis and posterior column damage ("up and in") (A) Paprosky type 2c acetabular defect. (B) Type 3a; the "up and out" defect. (C) Type 3b; the "up and in" defect. Chapter 32- Page 423
What are three types of spinal muscular atrophy?
Type I: Present at birth, floppy, early death from pneumonia (increased survival with better nutritional and pulmonary care) Type II: Present age 6 to 24 months, ambulation difficult Type III: Later presentation, normal life expectancy SMA Child with powered scooter Chapter 63 - Page 819
What is the major collagen in articular cartilage?
Type II collagen Chapter 35 - Page 460
How do complications from lateral condyle fracture Type III compare with Type II?
Type III have 3 times more complications compared to Type II Chapter 53 - Page 680
What is the treatment for Types II-IV supracondylar humerus fractures?
Types II - IV - closed reduction and pinning Chapter 53 - Pages 677-679
What is a common lower extremity injury associated with a posterior hip dislocation?
Up to 25% of patients will have an associated injury to their knee. Striking the knee on the dashboard during an MVA is thought to be a common mechanism of injury that results in a posterior hip dislocation. Photo shows a patient with a posterior hip dislocation. Chapter 31 - Page 399
If the investigator (orthopedic surgeon) is not "blinded" from the treatment allocation, this may lead the way the patient is treated. How has this been proven to affect the outcome?
Up to 40% over estimate of the effect of intervention "Observer bias" Chapter 15 - Page 169
What percentage of combat related residual limbs develop heterotopic ossification?
Up to 63% Chapter 41 - Page 543
What is the percentage of patients with adult deformity that present with stenosis and neurogenic claudication symptoms?
Up to 64% Chapter 45 - Page 588
How does IV gadolinium with MRI scans differentiate phlegmon and purulence? Which enhances?
Used to distinguish an abscess from a phlegmon, because the entire phlegmon will enhance, whereas the pus in an abscess will not (Phlegmon = inflammation of infected soft tissue or connective tissue, Purulence = drainable abscess) Chapter 8 - Pages 95-96
Measurement bias can be solved by what means?
Using valid and reliable measures Chapter 15 - Page 171
In Type I Seddon peripheral nerve injuries (Neurapraxia), what is the prognosis?
Usually 100% recovery in a matter of days and weeks Chapter 19 - Page 228
With brachial plexus injury, what is the most common nerve root level involvement and what side right or left?
Usually C5-C6 (Erb palsy), right side Chapter 55 - Page 710
In Type II Seddon peripheral nerve injuries (axonotmesis) what is the prognosis?
Usually reversible with incomplete recovery Chapter 19 - Page 228
Define vertical-center-anterior margin angle, VCA aka anterior center-edge angle (the angle of Lequesne)? What are the normal angles?
VCA (vertical-center-anterior margin angle) aka anterior center-edge angle Normal VCA > 25° VCA, patient positioning for X-ray and VCA measuring anterior coverage Arch Orthop Trauma Surg (2009) 129:787-791 The anterior center edge angle in Lequesne's false profile view: Interrater correlation, dependence on pelvic tilt and correlation to anterior acetabular coverage in sagittal plane. A cadaver study Chapter 58 - Page 744
Which antibiotics should not be used with an antibiotic bead pouch with initial care of open fractures and why?
Vancomycin should not be used initially for concern of developing resistant organism Chapter 5 - Page 51
The piriformis starting point is more appropriate for intramedullary nailing of subtrochanteric femur fractures because it is coaxial with the rest of the femur. By using the greater trochanteric starting point, what deformity may result if an entry portal that is too lateral is made?
Varus Deformity (NB anatomic reduction imperative before Subtrochanteric intramedullary nailing) Chapter 31 - Page 405
Fracture-dislocation of the cervical spine often has significant translational displacement and therefore commonly associated with spinal cord injury. What is the concern if there is a fracture of the transverse foramina and what is the sequelae?
Vertebral artery injury (11% of all cervical spine injuries) Most are asymptomatic For those that are symptomatic (embolization causing stroke) anticoagulation should be considered Vertebral artery injury from the fracture facet at C4-5 with reformatted CT scan Subaxial Cervical Spine Trauma Brian K. Kwon, et al. J Am Acad Orthop Surg February 2006; 14:78-89.
In the arteriole theory of vertebral osteomyelitis, the bacteria become entrapped and the end arteriole. This arteriole is near what part of the vertebra?
Vertebral endplate Chapter 43 - Page 565
Unlike adults massive hemorrhage from pediatric pelvic fracture is less likely. With a multiple trauma pediatric patient including a pelvic fracture, what is the most likely cause of massive hemorrhage?
Visceral injury Chapter 57 - Page 727
The typical findings of a patient with coxa vara?
Waddling gait with a painless limp (weak abductors 2° to hi ridding greater trochanter) Chapter 58 - Page 744
A stable slipped capital femoral epiphysis hip is defined as the ability for the patient to do what?
Walk or bear weight Chapter 58 - Page 746
What is the predominant component of articular cartilage?
Water Simon, Buckwalter, Orthopaedic Basic Science 2nd Ed Page 446
What finding confirms the diagnosis of pseudogout?
Weakly birefringent, rhomboid shaped calcium pyrophosphate dihydrate crystals. Chapter 18 - Page 220
What are the three steps of the Common Pathway?
What are the three steps of the Common Pathway? 1. Prothrombin to Thrombin 2. Fibrinogen to Fibrin 3. Fibrin to Cross-linked Fibrin Clot Chapter 12 - Page 138
What is a fillet type flap?
What is a fillet type flap? Axial pattern flaps taken from amputated or otherwise unused parts Chapter 5 - Page 53
What is the definition of coxa profunda?
When the floor of the acetabulum fossa touches the ilioischial line Coxa profunda, acetabular fossa touches ilioischial line Chapter 32 - Page 414
At what age do the early signs (Ortolani and Barlow signs) of hip dysplasia become no longer apparent?
When the infant reaches 3 to 6 months of age, the dislocated hip becomes contracted and the early signs may not be apparent. Chapter 58 - Page 740
The confidence interval determines the precision of the estimate of the effect. A small sample size will lower the precision and do what to the confidence interval?
Widened it (larger confidence interval) Chapter 15 - Page 173
An algorithm for anticipated blood loss in total knee and total hip patients predicts the postoperative hemoglobin. If the postoperative anticipated hemoglobin was less than 7, the patient was treated with preoperative erythropoietin. How did using this algorithm impact the transfusion (allogenic) rate?
With algorithm: 2.1% received allogenic blood Without algorithm: 16.4% received allogenic blood Blood management and algorithm with the use of erythropoietin Chapter 12 - Page 141
How does the age of the patient influence the risk of osteonecrosis following a pediatric femoral neck fracture?
With increasing age, there is a 1.14 with each year increased risk of osteonecrosis Chapter 57 - Page 729
What is the safest way of placing a medial epicondylar pin?
With the elbow in extension to avoid ulnar nerve entrapment Chapter 53 - Page 678
What timeframe should antibiotics be administered for an open fracture?
Within 3 hours Decreases the risk of infection Chapter 37 - Page 484
Soft-tissue coverage of open tibial fractures either by primary closure or by flap coverage has been shown to have a higher incidence of infection if not done by what time from the original fracture
Within 7 days Chapter 37 - Page 485
Tranexamic acid (antifibrinolytic agent) was most effective with total hip replacement in what population?
Women It was both cost effective reducing blood loss and the need for blood transfusions. Chapter 12 - Page 142
Typically what do routine X-rays show with chronic valgus instability?
X-rays are usually normal except for posterior medial osteophyte at the olecranon if there is valgus extension overload. Chapter 27 - Page 347
Does the disruption of the transverse plane force couple of the rotator cuff result in loss of function?
Yes Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 301 Chapter 24 - Page 299
Female athletes have a greater incidence of knee injuries compared to their male counterparts with running, jumping and pivoting sports. Is the same true for adolescent females?
Yes Increased risk for knee injuries including ACL in females 12-15 years of age. Chapter 61 - Page 784
Does anterior cervical plating offer less stiffness in flexion, torsion, and axial loading than segmental posterior stabilization technique?
Yes Resulting in higher rates of nonunion in patients undergoing multilevel anterior fusion and in patient with poor bone quality (anterior subaxial surgery limited to 2 or 3 motion segments) Chapter 48 - Page 632
Is surgical treatment more effective than non-surgical treatment for LCP disease in a child older than 8 at onset and with B or B/C group?
Yes Lateral pillar classification Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 745 Herring JA, Kim HT, Browne R: Legg-Calve-Perthes disease: Part II. Prospective Multicenter study of the effect of treatment on outcome. J Bone Joint Surg Am 2004;86 (10):2121-2134. Chapter 58 - Page 746
Can minimally displaced lateral condyle fractures (less than 2 mm) treated with a cast develop a nonunion?
Yes, but only a small percentage Can be treated with pinning when nonunion diagnosed Chapter 53 - Page 681
What patient type and fracture location is more likely to develop compartment syndrome?
Young patient with a diaphyseal tibia fracture Chapter 37 - Page 479
In which patient category does hip resurfacing show at least equivalent results to THA?
Younger, larger males with diagnosis of OA Chapter 32 - Page 423
An impending amputation with constriction band syndrome in a neonate is a surgical emergency. What surgical procedure is usually used?
Z-plasties Chapter 55 - Page 709
When a joint is at rest that is static equilibrium, the sum of all forces equals what?
Zero 4 A free-body diagram of the elbow in static equilibrium while holding a gallon of milk, which exerts a downward force of 37 N. Because this force acts at a distance of 0.2 m to the elbow, it also induces an extension moment (M = 37 N × 0.2 m = 7.4 Nm) around the elbow. Assuming that the biceps is the sole elbow flexor, the biceps muscle must create a flexion moment of equal magnitude for static equilibrium to exist. Because the biceps force acts at a distance of only 0.02 m to the elbow joint, it must generate a force (F = 7.4 Nm/0.02 m = 370 N) to counteract the extension moment. To complete the free-body diagram, the sum of all forces must also be zero. Because the biceps induces an upward force of 370 N, but the gallon exerts a downward force of only 37 N, an additional downward force (F = 370 N - 37 N = 333 N) must be generated as compressionat the elbow joint to equalize forces. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 63 Chapter 6 - Page 63
What are the four layers of articular cartilage?
Zone I: Superficial Zone II: Transitional Zone III: Radial Zone IV: Calcified NB: Tidemark separates zone III and zone IV Chapter 3 - Page 23
What is the weakest portion of the physis?
Zone of hypertrophy Chapter 61 - Page 784
What must accompany prescriptions for prosthesis under the Centers for Medicare and Medicaid Services?
"K" level of function Prosthetic prescription details including "K" level Reprinted with permission from Flynn,JM (ed) Orthopedic Knowledge Update 10, Rosemont Illinois American Academy of orthopedic surgeons, 2011 Page 544 Chapter 41-page 544
Provide the definition of "relative risk" and explain its interpretation.
"Ratio of the risk of an event among an exposed population (treatment A) to the risk among an unexposed population (control)" 10/100 (treated A.) divided by 20/100 = 0.5 or 50% For example, if the relative risk of an event is 0.5, that means that individuals in the exposed population is 50% as likely to experience that even compared to controls. Table 1 Chapter 15 - Page 168
What is the anti-Nogo IgG intrathecal approach (used in Switzerland) for spinal cord injury patients?
- Anti-Nogo antibody is administered intra-thecally to inhibit Nogo - IN-1 (Nogo) is a monoclonal IgM antibody that can block potential regeneration Chapter 44 - Page 576
List four features that suggests rupture of the transverse atlantal ligament.
1. 7 mm or greater overlap a lateral masses on open mouth 2. Bony avulsion fragments on CT suggesting loss of ligamentous integrity 3. Increase atlantodens interval on lateral view >3 mm in adults and >5 mm in children 4. MRI demonstrates ligamentous rupture Jefferson's Fracture, purple arrow showing avulsion of Transverse atlantal Ligament Dickman, Curtis A. M.D.. Greene, Karl A. M.D., Ph.D.. Sonntag, Volker K.H. M.D.. Injuries Involving the Transverse Atlantal Ligament: Classification and Treatment Guidelines Based upon Experience with 39 Injuries. Neurosurgery. 38(1):44-50, January 1996
What are five factors that increase the rate of polyethylene wear in total hip arthroplasty?
1. <50 years of age 2. More active patients 3. Non-highly cross-linked polyethylene 4. Thinner liner (less than 7 mm) 5. Larger femoral head (increased volumetric wear rates) Chapter 32 - Page 421
Type II odontoid fractures are the most common. Name four risk factors for increased nonunion.
1. >5 mm of posterior displacement 2. Fracture comminution 3. Inability to achieve or maintain reduction 4. Increased age >50 years Upper Cervical Spine Injuries R. Sean Jackson, J Am Acad Orthop Surg July/August 2002;10:271-280
What are the five classifications of the formal neurologic assessment according to the American Spinal Injury Association (ASIA) (i.e. A-E)?
1. A - Complete - no motor or sensory is preserved 2. B - Incomplete - sensory but no motor function below the neurologic level includes S4-S5 3. C - Incomplete - motor function preserved below the neurological level and more than ½ of the muscles below the level have a grade less than 3 4. D - Incomplete - motor function is preserved below the neurological level and at least ½ of the muscles below the level have a grade of 3 or more 5. E - Normal - normal motor and sensory Chapter 44 - Page 574
What three benefits occur with drilling the ACL femoral tunnel through a medial portal?
1. A more anatomic location 2. Closer recreation of native fiber orientation (less vertical as seen with transtibial drilling) 3. Reduced rotational instability Chapter 35 - Page 453
What three agents are recommended for VTE prophylaxis for patients undergoing an elective THA or TKA and an elevated risk of PE AND an elevated risk of bleeding?
1. ASA 2. Warfarin (INR equal to or less than 2) No chemoprophylaxis 3. Consider mechanical prophylaxis, rapid post op mobilization and patient education of the symptoms of VTE as well. Chapter 12 - Page 141
What three agents are recommended for VTE prophylaxis for patients undergoing an elective THA or TKA and a standard risk of PE with an elevated risk of bleeding?
1. ASA 2. Warfarin (INR less than 2) No chemoprophylaxis 3. Consider mechanical prophylaxis, rapid post op mobilization and patient education of the symptoms of VTE as well. Chapter 12 - Page 141
Children with Legg-Calve-Perthes disease who present with a Trendelenburg gait or antalgic limp with intermittent pain. Examination of the child typically reveals restriction of what two motions?
1. Abduction 2. Internal rotation Chapter 58 - Page 745
What are five clinical signs of Charcot-Marie-Tooth?
1. Abnormal gait 2. Intrinsic hand wasting 3. Unrecognized hip dysplasia 4. Bilateral cavovarus feet 5.Toe clawing Intrinsic hand wasting Chapter 63 - Pages 819-820
What are four characteristics of Poland's Syndrome?
1. Absence of the sternal head of the pectoralis major 2. Loss of breast tissue and chest wall deficiency 3. Brachydactyly affecting the index, long and ring fingers 4. Syndactyly Chapter 55 - Page 702 Green's Operative Hand Surgery 6th edition Page 1315
What are four common findings of ulnar longitudinal deficiency?
1. Absent ulnar side digits 2. Wrist in ulnar deviation 3. Forearm shortened 4. Elbow range of motion limited or absent Chapter 55 - Pages 700-701
Dichotomous results are expressed in "proportions"(relative) or absolute differences between risks. Example of "proportions" would be relative risk, relative risk reduction or odds ratio. What are three examples of absolute comparisons between risks?
1. Absolute risk reduction 2. Risk difference 3. Number needed to treat Chapter 15 - Page 167
When are overhead athletes experiencing pain with valgus instability including valgus extension overload?
1. Acceleration phase when there is high valgus load on the anterior band MCL 2. Deceleration phase of due to posteromedial impingement of the olecranon (Valgus Extension Overload: Chapter 27 - Page 346
What are four problems that can lead to pincer impingement?
1. Acetabular retroversion 2. Coxa profunda 3. Coxa protrusio (head extends medial to Ilioischial line) 4. LLD with short limb with overcoverage ( coxa profunda) Chapter 32 - Page 414
What are two characteristics of Constriction Band Syndrome?
1. Acrosyndactyly pathopneumonic 2. Constriction bands Acrosyndactyly: fingers were initially separated and then refused due to the bands Chapter 55 - Page 709
What is indicated surgically in the neonatal compartment syndrome in the acute phase and the late phase?
1. Acute phase: Emergency compartment release 2. Late phase (Volkmann's contracture): Release of entire flexor pronator origin, neural lysis and debridement of necrotic tissue Chapter 55 - Page 711
The deposition of calcium pyrophosphate dihydrate crystals in articular tissue is usually seen in older patients and asymptomatic. Name 5 patterns when symptomatic.
1. Acute synovitis (pseudogout) like gout 2. Exacerbation of pre-existing OA 3. Severe destructive pattern like neuropathic arthropathy 4. Symmetrical proliferative synovitis like RA 5. Involvement of intervertebral disc and ligaments like AS resulting in spinal stenosis Chapter 18 - Page 220
What are the seven indications for NPWT (negative pressure wound therapy)?
1. Acute traumatic wound management 2. Chronic wound management 3. Post elective surgical wounds 4. Partial-thickness burns 5. Ulcers 6. Flaps 7. Skin grafts Chapter 5 - Page 51
What are three principal components of the intervertebral disk?
1. Annulus fibrosus 2. Nucleus pulposus 3. End plates Figure displays the biomechanics of an intact intervertebral disk. Chapter 3 - Page 28
Which two compartments in the leg are most susceptible to compartment syndrome?
1. Anterior 2. Deep posterior Chapter 37 - Page 479
In the two-step acromioplasty procedure what are the two steps?
1. Anterior acromionectomy 2. Anterior-inferior acromioplasty The two-step modification of the Neer acromioplasty procedure includes an anterior acromionectomy (A) followed by an anteroinferior acromioplasty (B). When performed arthroscopically, the anterior deltoid origin must remain intact and determines the extent of anterior acromionectomy. C, The undersurface of the acromion is rendered smooth with a bone rasp (arrow) or arthroscopic shaver or burr. D, In an open procedure, the deltoid is meticulously repaired to bone; when performed arthroscopically, the deltoid is respected and left intact. Reproduced with permission from Rockwood CA Jr, Lyons FR: Shoulder impingement syndrome: Diagnosis, radiographic evaluation, and treatment with a modified Neer acromioplasty. J Bone Joint Surg Am 1993;75:409-424. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 308 Chapter 24 - Page 306
Name five concomitant injuries associated with anterior shoulder dislocation in the pediatric population?
1. Anterior bony labrum 2. Labral lesions (Bankart injury, SLAP) 3. Hill-Sachs lesion (posterior lateral humeral head compression fracture) 4. Rotator cuff muscle tear 5. Subscapularis or lesser tubercle avulsion Chapter 61 - Page 788
Describe two forces that result in a flexion-teardrop injury of the cervical spine vertebral body?
1. Anterior column loss of integrity from flexion (The vertebral body is often pushed back into the spinal canal) 2 Posterior ligamentous complex loss of integrity in tension. Flexion-teardrop injury = teardrop-shaped (triangular) fragment avulsed from anterior edge of the rostral vertebral body while vertebral body pushed into spinal canal Chapter 48 - Page 634
What two augmentations can be done to reduce sacral fixation failure rate in long fusions?
1. Anterior column support 2. Iliac screw fixation (96% fusion rate with both combined) Chapter 45 - Page 588
What are four anterior stabilizing structures to prevent anterior shoulder dislocation?
1. Anterior glenoid rim 2. Labrum 3. Capsule and ligaments 4. Humeral insertion of capsule and ligaments Anterior stabilizing structures including glenoid rim, labrum, anterior inferior glenohumeral ligament, capsule and humeral insertion Chapter 24 - Page 299
What are two injured structures underlies varus posteromedial rotatory instability?
1. Anterior medial facet of the coronoid (due to impaction of humeral trochlea) 2. Rupture of the LCL complex. Chapter 27 - Page 346
What are two surgical options with a displaced Type II odontoid fracture?
1. Anterior odontoid screw placement (single screw mechanically sufficient) 2. C1-C2 arthrodesis posteriorly Odontoid Type II treated with single cannulated screw Chapter 48 - Page 631
What are four consequences of confirming that there is a vertebral artery injury from acute cervical injury?
1. Anti-embolic coverage to prevent stroke 2. Preservation of remaining intact artery during surgery 3. Expedient surgical instrumentation of the injured segments 4. Early surgical stabilization versus prolonged recumbency Chapter 48 - Page 636
What are three nonoperative treatment strategies for elbow osteoarthritis?
1. Anti-inflammatory drugs 2. Activity modifications 3. Corticosteroid injection Chapter 27 - Page 343
Name eight medication based pain management modalities for residual limb pain.
1. Anti-seizure medication (gabapentin) 2. Tricyclic antidepressants-amitriptyline 3. Selective serotonin reuptake inhibitors (SSRIs)-Prozac, Paxil 4. Nonsteroidal anti-inflammatory 5. N-muscle-D-asparic acid (NMDA) receptor antagonist-tramadol, Demerol, tramadol 6. Long-acting narcotics 7. Patient-controlled analgesia (PCA) 8. Regional analgesia Chapter 41 - Page 541
What are two examples when early range of motion program should be instituted to prevent elbow stiffness?
1. Any injury that does not require surgical treatment (nondisplaced radial head fracture) 2. Injuries requiring surgical treatment should be fixed in a stable manner so that the rehabilitation process can begin a few days following surgery. Chapter 27 - Page 344
The development of a limb bud is dependent on the interaction of which three regions?
1. Apical ectodermal Ridge (AER)-ectodermal condensation 2. Limb Mesenchymal cells 3. Zone of polarizing activity (ZPA) The apical ectodermal ridge is a thickened epithelium at the most distal end of the limb bud. The zone of polarizing activity is at the posterior part of the limb bud Gilbert, Scott F. "Developmental Biology". 9th ed., 2010
What 2 techniques can be used to prevent proximal femoral epiphysis displacement when reducing a pediatric hip dislocation?
1. Appropriate sedation or anesthesia 2. Fluoroscopic guided reduction Chapter 57 - Page 728
When converting from arthroscopic rotator cuff repair to open surgery, what must be done to help in preventing infection?
1. Arthroscopic portals closed 2. Shoulder reprepped and draped Chapter 24 - Page 306
What are three characteristics of Ulnar Dimelia?
1. As many as 8 fingers but no thumb 2. Mirror hand centered at the index finger 3. No radius and 2 ulnas Chapter 55 - Page 708
What are four characteristics of Radial Longitudinal Deficiencies?
1. Associated with syndromes 2/3rds of the time 2. Chromosome challenge test for Fanconi anemia indicated (prevent complete bone marrow failure) 3. The most common deformity is absent radius 4. Associated with bone marrow, GI, heart, kidney abnormalities Chapter 55 - Page 698
What two types of meniscus tears should not be repaired?
1. Asymptomatic tears during arthroscopy 2. Nondisplaceable tears < 1cm Chapter 35 - Page 459
What are three phases of untreated neonatal compartment syndrome?
1. At birth, edematous limb with necrosis or ischemic tips 2. Limb progression to necrosis and digital contracture 3. Late phase, Volkmann's ischemic contracture Chapter 55 - Page 711
What are five symptoms of Friedreich's ataxia?
1. Ataxia 2. Dysarthria 3. Weakness 4. Loss of deep tendon reflexes 5. Loss of vibratory sense and proprioception ADLs scoring system for Frederick's ataxia Chapter 63 - Page 820
What are two genetics of spinal muscular atrophy?
1. Autosomal recessive 2. Chromosome 5q Chapter 63 - Page 819
What complication can occur in the Pavlik harness with abduction greater than 60° or forced abduction?
1. Avascular necrosis Avascular necrosis of the left dysplastic hip treated with Pavlik harness and forced abduction Chapter 58 - Page 742
What are three things that should be done with periosteum, muscle and nerves during amputation?
1. Avoid periosteal stripping to minimize heterotopic bone 2. Myodesis to bone is preferred when possible 3. Nerves should be cut sharply with slight tension to promote retraction into muscle Example of myodesis of transfemoral amputation Chapter 41 - Page 538
What 3 parameters can minimize the risk of compartment syndrome with early application of spica casts for pediatric femur fractures?
1. Avoiding excessive traction 2. Knee flexion greater than 90° 3. Smooth contoured popliteal fossa Chapter 57 - Page 732
What are three loading modes?
1. Axial 2. Torsional 3. Bending (May only test 1 or 2 modes given clinical importance, results obtained in one mode may not be applicable to a another mode) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 66 Chapter 6 - Page 66
What are two contributors to Heterotopic Ossification in amputation?
1. Blast injuries 2. Amputation through the zone of injury is believed to contribute Radiograph showing post-traumatic heterotopic ossification (from OKU 10) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 543 Chapter 41 - Page 543
What are two broad categories of treatment options for osteochondral lesions of the talus?
1. Bone Marrow stimulation- Microfracture to stimulate fibrocartilage formation small to medium sized cartilage lesions. 2. Osteo-articular tissue transplantation (OATs) for larger chondral injuries, bone and cartilage lesions, or failed microfracture procedures Chapter 40 - Page 526
How does cerebral palsy scoliosis differ from idiopathic? List five ways.
1. C Shaped Curves 2. Begins at earlier age 3. Bracing does not change the outcome but can be used as a support for positioning and comfort 4. Surgery has higher complication rate (infection and bleeding) 5. Larger Curves Chapter 63 - Page 813
Most Type I and Type II Hangman's fractures can be treated conservatively. The unstable Type IIA fracture (C2-C3 disc disruption with accompanying kyphosis and translation) require what two surgical procedures?
1. C1-C3 posterior instrumented fusion (more biomechanically sound) 2. Anterior C2-C3 cervical decompression and instrumented fusion (advantage: preserves atlanto-axial motion, but is more technically difficult) Hangman's fracture Type IIA with C2-3 HNP and anterior arthrodesis with iliac crest graft and plate Chapter 48 - Page 631
What are five key upper extremity motor exams to determine the cervical spine neurologic level?
1. C5: Elbow flexion 2. C6: Wrist extension 3. C7: Elbow extension 4. C8: Long finger flexion 5. T1: Small finger abduction Chapter 44 - Page 573
If vertebral artery injury is suspected, what are two diagnostic studies?
1. CT angiography with 3-D reformatting 2. Magnetic resonance angiography CT angiography with 3-D reformatting demonstrating vertebral artery injury Chapter 48 - Page 636
What are two appropriate procedures for stage IIA adult acquired flatfoot?
1. Calcaneal medial slide (hindfoot valgus corrected) 2. Tendon transfer (flexor digitorum longus) Medial calcaneal slide Chapter 40 - Page 527
What are three types of FAI (femoracetabular impingement)
1. Cam- femoral side with abnormal shaped proximal femur 2. Pincer 3. Most commonly combined (80%). Photo is of a radiograph of the pelvis of a 27-year-old man with advanced cam-type FAI. The patient has asphericity of the femoral head depicted by extensionmof the lateral aspect of the femoral head outside the red circle. Chapter 32 - Page 414
Name thirteen associations with Guillain-Barré syndrome.
1. Campylobacter intestinal infection (most common) 2. Cytomegalovirus, CMV (second most common) 3. Influenza virus 4. HIV 5. Herpes simplex 6. Mononucleosis (Epstein-Barr virus or CMV) 7. Systemic lupus erythematosus 8. Hodgkin's disease 9. Bacterial infection 10. POST OPERATIVE 11. Vaccinations 12. Critically ill (neuropathy of critical illness) 13. Childbirth D.A.M. Medical Encyclopedia. Guillain-Barre syndrome Landry-Guillain-Barre syndrome; Acute idiopathic polyneuritis; Infectious polyneuritis; Acute inflammatory polyneuropathy; Acute inflammatory demyelinating polyneuropathy Last reviewed: May 21, 2012. Chapter 19 - Page 232
What are four effects on cartilage of mechanical injuries?
1. Cell death due in part to free radicals and oxidative damage (mechanically stressed him chondrocytes release oxidants) 2. Matrix injury 3. Reparative responses 4. Possibly continued degeneration and post-traumatic OA A.: 4 weeks post articular cartilage injury (cell death and matrix injury) B.: 48 weeks post articular cartilage injury (reparative response but defect residual) Chapter 3 - Pages 25-26
What are three characteristics of central cord syndromes?
1. Central cord injury resulting in greater weakness in upper extremities than lower extremities 2. More common in elderly individuals, low energy falls 3. Pre-exiting cervical spondylosis and stenosis with "kinking" Cervical spinal cord cross-section: Dorsal column tracts and Lateral cortical spinal tract demonstrates orientation of cervical lumbar and sacral distribution (C,L,S) Chapter 44 - Page 575
What are two most common areas of the talus for osteochondral lesions?
1. Central medial (most common and largest) 2. Central lateral Chapter 40 - Page 526
What other three factors widen the confidence interval?
1. Changing the size of the confidence interval to a larger percentage ( i.e. 99%) 2. Level of variability 3. Spread of possible treatment effects A forest plot showing two fictitious trials. Both have relative risk reductions of 50% in favor of the experimental group. Trial 1 denotes a larger trial with a more precise estimate of treatment effect (the 95% CIs are narrow). Trial 2 has fewer patients, fewer events, and is less precise in its measure of treatment effect. The solid vertical line denotes a fictitious level of clinical significance (this level can be based on clinical judgment and what surgeons believe is a clinically important result). Trial 1 is both clinically and statistically significant. That is, the CI does not include either the line indicating clinical significance or 1 (the line of no effect). Trial 2, however, is neither statistically nor clinically significant. Chapter 15 - Page 173
What are three most important steps to take after a knee dislocation and reduction?
1. Check vascular status with serial NV exams 2. Perform ABI 3. X-ray verification reduction in reduced position Chapter 35 - Pages 457-458
What are two concerns should a surgeon consider when faced with a patient that has repeat or multiple fractures?
1. Child abuse 2. Pathologic conditions (Osteogenesis imperfecta, Bone tumors, Neuromuscular conditions) Chapter 57 - Page 731
What are three characteristics of Pyrophosphate Arthropathy (Calcium pyrophosphate deposition disease)?
1. Chondrocalcinosis, or calcification of cartilage, may be present, especially in the knee (meniscus), symphysis pubis, and wrist (TFC) 2. Mineralization of the bones is usually preserved 3. Joint-space narrowing is usually uniform, and large osteophytes may be present, especially in non-weight bearing joints. Chondrocalcinosis of the knee Chapter 8 - Page 85
What are two opposing effects of chondrocytes on cartilage matrix?
1. Chondrocytes synthesize matrix components 2. Chondrocytes synthesize proteases that degrade matrix. Diagram demonstrates chondrocyte degradation of matrix and type II collagen with feedback mechanisms (if this balance is disturbed the result is osteoarthritis) Chapter 3 - Page 23
The inability to reduce a shoulder dislocation closed can result from what three situations?
1. Chronic dislocation 2. Interposed soft tissue including rotator cuff tear 3. Buttonholing of humeral head under conjoined tendon Chapter 24 - Page 301
What are three symptoms of fixed sagittal imbalance syndrome?
1. Chronic low back pain worsened with prolonged standing 2. Pitched forward posture 3. Knees in flexion Chapter 45 - Page 589
What are the rates of the two risks associated with anterior thoracolumbar approach?
1. Chronic pain in 32% 2. Asymmetry and abdominal bulging in 45% Chapter 45 - Page 588
What are two concrete findings of a meniscal tear in children?
1. Clearly show a tear that communicates with the surface of the meniscus 2. Displaced flap Chapter 61 - Page 785
If there is a history of cephalosporin allergy, 1 of these 2 antibiotics should be given.
1. Clindamycin 2. Vancomycin Chapter 43 - Page 571
What are three steps of treatment for unilateral facet fracture-dislocation?
1. Close reduction through traction 2. Post reduction MRI to rule out neural element compression 3. Halo or cervicothoracic brace Chapter 48 - Pages 633-634
What are two steps in treatment of an acute posterior dislocation?
1. Closed reduction 2. Immobilization and external rotation (short period) Chapter 24 - Pages 302-303
Close reduction should be attempted carefully with hyperextension injuries in the ankylosed spine given high risk of secondary spinal cord injury. What are two reasons that early surgical intervention is important with hyperextension injuries in the ankylosed spine?
1. Closed reduction is difficult to maintain 2. Epidural hematoma formation Irregular fracture planes on MRI indicate unstable fracture-dislocation Chapter 48 - Page 634
Bilateral facet fracture-dislocations are the results of extreme flexion and has a high incidence of spinal cord injury. What are three steps of initial treatment?
1. Closed reduction with close neurologic monitoring (higher risk of neurologic injury during reduction) 2. MRI 3. Posterior segmental stabilization and decompression Bilateral facet fracture-dislocation with 50% or greater overlap Chapter 48 - Page 634
Because of the complications associated with open reduction of radial neck fractures, what four things should first be attempted at reduction?
1. Closed reduction with percutaneous pin 2. Intramedullary pin reduction 3. Manipulation with curved elevator 4. Stout pin placed distal and posterior to the fracture to lever the radial head back into the neck Chapter 53 - Pages 682
Name four foot deformities that occur with meningomyelocele.
1. Club foot, equinovarus 2. Congenital vertical talus 3. Calcaneal valgus 4. Metatarsus adductus Chapter 63 - Page 817
Lateral mass fracture of the atlas can result in atlantoaxial instability with cord compression. If not treated appropriately what two additional problems can result?
1. Cock-robin head position 2. Suboccipital headache Sagittal split fracture of lateral mass resulting in incongruity of C1 lateral mass with both the occipital condyle and the C2 superior articular process Cock Robin head position from a C1 lateral mass fracture Chapter 48 - Page 630
What are three major components of articular cartilage?
1. Collagen (15%) 2. Proteoglycans (15%) 3. Water (>70% wet mass) Chapter 3 - Page 23
What are two most challenging areas to reconstruct in a simple syndactyly? (Remember some syndactyly can extend to the tip of the fingers)
1. Commissure (the normal juncture of 2 fingers proximally)-free of any suture lines and grafts to prevent scarring and contracture 2. Lateral nail fold
What are two characteristics of the annulus fibrosus?
1. Concentric, lammellar organization of type I collagen fibers around nucleus pulposus 2. Cells produce both type I and II collagen; fibroblast-like Collagen fibers orientation and each layer alternates between +65° and -65° Chapter 3 - Page 28
1. What are two usual treatments for High Grade burst fractures of the cervical spine? 2. What procedure is added it if there is poor bone quality or concerns for stability?
1. Corpectomy, anterior strut grafting and rigid anterior plate fixation 2. Posterior instrumentation can be utilized in conjunction if there is concern about stability or poor bone quality. Corpectomy for high grade burst fracture of C3 Chapter 48 - Page 633
What are four disadvantages of Low Molecular Weight Heparin (LMWH)?
1. Cost 2. Bleeding risk 3. Heparin-induced thrombocytopenia risk 4. Post op wound drainage Chapter 12 - Page 139
Name five challenges faced when performing a randomized control trial in orthopedic surgery.
1. Cost 2. Coordination 3. Data safety committees 4. Varying levels of expertise among participating surgeons 5. Ethical concerns regarding new devices and sham surgery as placebo (difficult to compare surgery A with not doing surgery A-sham surgery) Chapter 15 - Page 169
Name 5 other complications of pediatric femoral neck fractures (other than osteonecrosis and non-union).
1. Coxa vara 2. Coxa Valga 3. Coxa Magna 4. Premature physeal closure 5. Leg length discrepancy Chapter 57 - Page 729
What are two considerations for fixation of distal femur physeal fractures to avoid a septic knee?
1. Cross K wire fixation, using retrograde or antegrade methods (anatomic reduction) a. Retrograde method-pins placed from epiphysis to metaphysis through skin then the tip is bent and buried (no pin in knee joint b. Placing pins from metaphysis to epiphysis and buried pin proximally (no pin in knee joint) 2. Screw fixation for metaphyseal and epiphyseal fractures avoiding growth plate Chapter 59 - Pages 754-755
What three tests are used to diagnose AC joint pathology?
1. Cross arm adduction test 2. Pain with direct AC pressure 3. Active compression test Cross-arm adduction test Chapter 24 - Page 304
What two complications can occur with nonunion of lateral condyle fractures?
1. Cubitus valgus 2. Tardy ulnar nerve palsy Chapter 53 - Page 681
What are two indications for surgical intervention for thoracic scoliosis in Duchenne muscular dystrophy?
1. Curve greater than 40° 2. Progressive respiratory insufficiency Chapter 19 - Page 234
Before the age of 40 with adult scoliosis present with the symptoms of adolescence idiopathic scoliosis. Name four concerns typical of this patient population.
1. Curve progression 2. Long-term sequelae 3. Poor cosmesis 4. Low back pain Chapter 45 - Page 585
What are three indications for decompression with limited fusion with adult scoliosis?
1. Curves less than 20° 2. Unstable single segment (i.e. degenerative spondylolisthesis) 3. Unstable segment outside of a major curve Chapter 45 - Page 589
Give the five steps of how aspirin affects blood clotting, starting with it's effect on cyclooxegenase.
1. Cyclooxegenase (COX) converts arachadonic acid to prostaglandins and precursors to thromboxane 2. Aspirin inhibits cyclooxygenase therefore decreases thromboxane 3. Thromboxane (lipid) binds to thromboxane receptors on platelets cell membrane 4. Thromboxane-thromboxane receptor binding stimulates platelet aggregation and platelet activation 5. Aspirin therefore decreases platelet aggregation Chapter 12 - Page 138
List four surgical treatment algorithms for vertebral osteomyelitis.
1. Debridement of infectious foci and necrotic material 2. Relieving pressure on neural elements 3. Restoring alignment 4. Rigid fixation, when necessary Chapter 43 - Page 569
Anterior subaxial neck procedures can be divided into what three phases?
1. Decompression (discectomy or corpectomy) 2. Anterior column reconstruction 3. Anterior stabilization (low-profile plate with unicortical or bicortical locked fixation) Chapter 48 - Page 632
What are two functions of the menisci?
1. Decrease joint forces by increasing tibiofemoral surface contact area 2. Provide a dampening mechanism for excessive joint loads Chapter 35 - Page 458
What are three biomechanical measurement changes of the hip with coxa vara?
1. Decrease shaft neck angle 2. Decreased distance articular-trochanteric 3. Increased femoral retroversion Chapter 58 - Page 744
What are two electrodiagnostic findings of axonal injuries (crush or stretch injury)?
1. Decreased amplitude 2. NCV & latency maybe normal (unless the myelin sheaths are also affected then slight prolongation in latency and slowing in conductance velocity)
The initial inflammatory cytokines of Cartilage negatively impact Cartilage in what 2 ways.
1. Decreased collagen synthesis 2. Increased degradative proteases (matrix metalloproteinases, interleukin-6, interleukin-8 prostaglandin E2, nitric oxide and bone morphogenic protein-2)
What two age-related changes in chondrocyte phenotype may contribute to OA?
1. Decreased matrix biosynthesis 2. Increased expression of catabolic cytokines and matrix proteases Chapter 3 - Page 25
At birth, what are four clinical presentations of spinal muscular atrophy?
1. Decreased muscle tone 2. Weak muscles 3. Difficulty breathing 4. Difficulty feeding Sarnat HB. Spinal muscular atrophies. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Elsevier; 2011:chap 604.2. Chapter 63 - Page 819
Femoral head necrosis is greatest and least in which two Delbet classifications?
1. Delbet type 1 transphyseal injuries (38%) 2. Delbet type 4 intertrochanteric (5%) The Delbet classification of hip fractures in children and adolescents. A, Type I, transphyseal fracture, with or without dislocation of the capital femoral epiphysis. B,Type II, transcervical fracture. C, Type III, cervicotrochanteric fracture. D, Type IV, intertrochanteric fracture. (Adapted with permission from Hughes LO, Beaty JH: Fractures of the head and neck of the femur in children. J Bone Joint Surg Am1994;76:283-292.) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 729 Chapter 57 - Page 729
What are five features of amyotrophic lateral sclerosis (Lou Gehrig's disease) that determine its diagnosis?
1. Demonstration of upper & motor lower neuron involvement 2. Lower motor neuron dominance 3. Limited distribution in same segment or single extremity 4. ABSENSE OF PAIN OR SENSORY SYMPTOMS 5. Progression over months both within and between different body regions THESE PATIENTS CAN BE MISDIAGNOSED AND UNDERGO UNNECESSARY SURGERY FOR CERVICAL RADICULOPATHY OR MYELOPATHY Chapter 19 - Page 236
What two conditions accelerate disc degeneration and suggest a vascular etiology to disc degeneration?
1. Diabetes 2. Tobacco usage Chapter 3 - Page 30
What four patient factors are associated with the development of tibial shaft nonunions?
1. Diabetes 2. History of prior nonunion 3. Smoking 4. Poor nutrition Chapter 37 - Page 486
What are two endocrine disorders and one vitamin deficiency frequently associated with neuropathy?
1. Diabetes mellitus 2. Hypothyroidism Vitamin B12 deficiency Chapter 19 - Page 230
What are two changes in bone, specifically the femur, as we age and become osteoporotic?
1. Diameter increases and thickness of the cortex decreases 2. The bending stiffness increases with the increased cortical diameter to compensate for the decreased thickness and material properties of bone Illustration showing the influence of cross-sectional geometry on bending stiffness of basic structures. For example, increasing the outer diameter of a cylindrical structure from 10 mm to 12 mm while retaining a wall thickness of 2mm increases bending stiffness (I) by 82%. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 62 Chapter 6 - Page 62
Results of high-quality clinical studies help clinicians make the best decision for their patients. These results are based on outcomes. What are two types of general outcomes?
1. Dichotomous (either occur or do not occur) 2. Continuous (scale, value, numbers, percentages etc.) Chapter 15 - Page 167
What are six guidelines that can help determine if the subgroup effect is real?
1. Did the hypothesis precede or follow analysis? 2. What is the subgroup difference one of the small number of hypothesize effects? 3. Is the magnitude of the subgroup difference large? 4. Is the subgroup difference consistent? 5. Was the subgroup difference statistically significant? 6. Does the external evidence support the hypothesize subgroup difference? Chapter 15 - Page 172
What three factors should be considered when determining if someone needs a blood transfusion
1. Difficulty or complexity of the surgery 2. Preoperative hemoglobin level 3. Medical comorbidities Chapter 12 - Page 141
What are four characteristics of Macrodactyly?
1. Digit overgrowth 2. Can occur from neurofibromatosis, spontaneous or with other syndromes 3. Progressive digit enlargement is most common 4. Treatment debulking or amputation Chapter 55 - Page 708
Early (less than 72 hours) surgical spine intervention in trauma cases has been shown to be safe with thoracolumbar spine fractures. Besides the anticipated benefit of better neurologic recovery, what are three other advantages of early intervention?
1. Diminished length of stay 2. Decreased intensive care stay 3. Decreased chance of pulmonary deterioration Chapter 48 - Page 629
What are three typical radiographic changes in vertebral osteomyelitis?
1. Disc space narrowing 2. End plate irregularity 3. End plate sclerosis Chapter 43 - Page 566
Most atlas (C1) fractures can be treated non-surgically with immobilization. What two subtypes require surgical intervention including disruption of what soft tissue structure?
1. Disruption of the transverse atlantal ligament (TAL) such as a Burst fracture 2. Displaced fracture of lateral mass such as sagittal split injury (requires early ORIF) Risk of instability of C1-C2 and neurologic injury Chapter 48 - Page 630
Hyperextension cervical spine fractures are most commonly associated with what two types of spine conditions?
1. Disseminated idiopathic skeletal hyperostosis (DISH) 2. Ankylosing spondylitis C6-C7 extension injury in DISH patient Chapter 48 - Page 634
With established deformity and symptomatic in Madelyn's deformity, what three procedures have been effective?
1. Dome osteotomy of the radius 2. Ulnar shortening (diminished ulnar carpal impaction) 3. Combination of the above 2 procedures Chapter 55 - Page 711
What are two types of peritalar subluxation?
1. Dorsolateral: Adult acquired flatfoot 2. Plantar medial: Subtle cavus foot Adult acquired flatfoot demonstrating peritalar subluxation Chapter 40 - Page 527
With anterior locking plates bicortical fixation is usually recommended for trauma cases. What are two risks of bicortical fixation in this situation?
1. Dural tear 2. Neurologic injury Chapter 48 - Page 632
What are two preferred managements for toe walking gait?
1. Dynamic deformity treated with botox and casting/bracing 2. Surgery for fixed contractures and to prevent recurrence Surgery most effective in children over 6 years More selective gastrocnemius lengthening or intramuscular fascial lengthening preferred Chapter 63 - Page 815
What are three stages of Lyme disease?
1. Early infection with localized erythema migranes 2. Disseminated infection 3. Late stage infection Chapter 19 - Page 234
What three measures can be taken to prevent posttraumatic or postoperative elbow stiffness?
1. Early range of motion exercises 2. Static progressive splinting 3. Continuous passive motion (CPM) Authors of one study concluded that there was no benefit of CPM after open contracture release. Manipulation under anesthesia is safe and valuable. Photo shows static progressive splinting. Chapter 27 - Page 344
What is the impact of the densely packed negatively charged glycosaminoglycan on cartlidge properties?
1. Electrostatic repulsion from densely packed negative charged glycosaminoglycans on the aggregate enables the cartilage to resist deformation under compression. Glycosaminoglycans on the aggregates mixed with collagen fibrils and chondrocytes. Chapter 3 - Page 23
Brachial plexus injuries can be severe with nerve rupture or root avulsions. What three physical findings suggest nerve root avulsion?
1. Elevated hemidiaphragm on inspiratory imaging (phrenic nerve dysfunction) 2. Horner's syndrome 3. Scapular winging Chapter 55 - Page 710
What are two procedures for management of vertebral artery injury with acute cervical injury?
1. Endovascular stenting 2. Embolization Chapter 48 - Page 636
What are three radiographic hallmarks of rickets?
1. Enlargement of the rib ends 2. Widening of the proximal humeral plates 3. Subcortical bone resorption at the inferior scapular angles Chest radiograph of a 13-month-old boy with failure to thrive shows enlargement of rib ends (rachitic rosary) (short arrows) and widening of the physis of the proximal humerus (long arrow) consistent with rickets. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 88 Chapter 8 - Page 88
Name eight intraoperative methods that can reduce the need for allogenic blood transfusion.
1. Epidural or spinal anesthesia 2. Intraoperative blood salvage 3. Hemodilution 4. Anti-fibrinolytic agents 5. Bipolar Sealing device 6. Preoperative injections 7. Topical agents 8. Computer assisted minimally invasive technique Bipolar sealing device Chapter 12 - Page 142
Name five Biologic Response Modifiers used in the treatment of RA.
1. Etanercept 2. Adalimumab 3. Infliximab 4. Rituximab 5. Abatacept Chapter 18 - Page 218
Postoperative infections require prompt surgical debridement and IV antibiotics. What are four surgical goals in treating postoperative spine infections.
1. Evacuation of fluid collection 2. Thorough debridement of necrotic tissue 3. Stable instrumentation should be left in 4. Bone graft should be left in unless grossly contaminated Chapter 43 - Page 571
What are three effects of mechanical loading on disk degeneration?
1. Excessive loads may contribute to degeneration and pain 2. Dynamic loading is more tissue friendly compared to static loading 3. Physiologic loads may promote biosynthesis, maintain cellular phenotype, and repair. Chapter 3 - Page 31
What are three surgical factors that may increase the risk of nonunion of tibial shaft fractures?
1. Excessive stripping of soft tissue at the time of ORIF 2. Excessive reaming with violation of the endosteal blood supply 3. Distraction of the fracture site with IM nailing or ORIF Chapter 37 - Page 487
What is the most common type of fracture with ankylosing spondylitis and what levels do they usually occur?
1. Extension-type 2. C5-C7 (can also have odontoid fractures) Chapter 48 - Page 635
What is the treatment for refracture while using external fixators for pediatric femur fractures?
1. External fixator should remain until solid union radiologically 2. Consideration of leaving pins for a few days after removal of fixator therefore if the fracture recurs the fixator can be replaced Chapter 57 - Page 734
What are three characteristics of Preaxial polydactyly?
1. Extra thumb 2. Most often is sporadic, unilateral, and occurs in whites 3. The most common is Wassell type 4 with duplicate proximal and distal phalanx Chapter 55 - Page 706
List the inflammatory arthropathy associated with each organ system involvement. 1. Eyes 2. GI 3. GU 4. Nervous system
1. Eyes -> Behcet disease & spondyloarthritis 2. GI -> Crohn's disease 3. GU -> Reactive arthritis & Gonococcemia 4. Nervous system -> Lyme disease Chapter 18 - Page 217
What are the seven Primary Classifications of Congenital Anomalies?
1. Failure of formation (Secondary Class: Transverse and Longitudinal arrest) 2. Failure of differentiation 3. Duplication 4. Overgrowth 5. Undergrowth 6. Constriction band syndrome 7. Gen. skeletal abnormality Chapter 55 - Page 697
Give four early X-ray signs of avascular necrosis.
1. Failure of ossification of nucleus within 1 year after reduction 2. Broadening of femoral neck 3. Increased density or fragmentation of capital femoral epiphysis 4. Residual deformity of femoral head and neck after ossification Avascular necrosis of left hip with broadening and shortening of the metaphysis (large arrow), a small irregularly shaped ossification center of the femoral head (open arrow), and dysplastic changes in the acetabular roof (curved arrow) Chapter 58 - Page 743
A recent prospective randomized study revealed that surgical repair of the medial retinacular structures in a primary dislocation had no advantage over nonsurgical management. What are the five indications for surgery after a patellar dislocation?
1. Failure to improve 2. Concurrent osteochondral injury 3. Continued gross instability 4. Disruption of the medial patellofemoral ligament and vastus medialis obliquus 5. High level athletic demand coupled with mechanical risk factors Chapter 61 - Page 785
List four main indications for surgery in the setting of vertebral osteomyelitis.
1. Failure to obtain a culture via blood or CT-guided biopsy 2. Failure of medical therapy 3. Neurologic demise 4. Structural decompensation Chapter 43 - Page 569
What are three risk factors for recurrent patella dislocation?
1. Female gender 2. Young age of first dislocation 3. Soft tissue laxity Chapter 61 - Page 784
What combined surgical salvage procedures is done for a painful dislocated hip with bony changes for better sitting in CP patients?
1. Femoral head resection 2. Derotational valgus osteotomy Spastic quadriplegic with progression from A-> B now painful flat head underwent femoral head resection and valgus derotational osteotomy. E. = femoral head extensive cartilage defect Chapter 63 - Page 814
What are four common sites MRI can help to identify occult fractures?
1. Femoral neck 2. Scaphoid 3. Tibial plateau 4. Talar neck Chapter 8 - Page 96
Nonsurgical treatment for coxa vara is ineffective. What are three indications for valgus derotational osteotomy?
1. Femoral neck-shaft angle <90° (nl = 120-135°) 2. Hilgenreiner's angle >60° (nl <25) 3. Physeal angle >45° (Physeal- shaft angle, nl <12°)?? Chapter 58 - Page 744
In the Pavlik harness, the hips are held in flexion between 90 and 100° and abduction is slowly and gently gained by stretching of the hips. What 2 complications can occur from hyperflexion?
1. Femoral nerve palsy 2. Inferior hip dislocation Pavlik harness Chapter 58 - Page 742
What associated three injuries must the surgeon consider when reducing a pediatric hip dislocation?
1. Femoral physeal fracture 2. Sciatic nerve injury 3. Concomitant ipsilateral knee injury Chapter 57 - Page 728
If hip subluxation is more severe with bony changes, what two surgical procedures can be performed in CP patients?
1. Femoral varus rotational osteotomy 2. Periacetabular osteotomy if acetabular dysplasia Chapter 63 - Page 814
What are the seven increased perinatal risks for brachial plexus injury
1. Fetal macrosomia 2. Prolonged or difficult labor 3. Shoulder dystocia 4. Breech presentation 5. Forceful extraction with vacuum or forceps 6. Uterine anomaly 7. Previous child with brachial plexus injury Chapter 55 - Page 709
List the inflammatory arthropathy associated with each systemic feature. 1. Fever 2. Rash 3. Nail abnormalities
1. Fever -> SLE and septic arthritis 2. Rash -> SLE & psoriatic arthritis 3. Nail abnormalities -> psoriatic & reactive arthritis Chapter 18 - Page 217
What are four advantages of rBMP-2 for open tibial shaft fractures in the BESTT trials?
1. Fewer secondary procedures 2. Faster time to union 3. Lower nonunion rates 4. Less infection Chapter 37 - Page 485
What are two EMG findings with acute nerve injury of the axon which is severe (axonotmesis) i.e. denervation?
1. Fibrillation 2. Reduced recruitment of motor units (voluntary muscle contraction) Chapter 19 - Page 230
The posterior lateral corner consists of dynamic and static stabilizers. Name the three main static stabilizers.
1. Fibular collateral ligament(FCL) 2. Popliteofibular ligament 3. Posterolateral capsule (The popliteal fibular ligament arises from the musculotendinous junction of the popliteus and attaches to posterior aspect of the fibular head) Chapter 35 - Page 455
Which four joints can be involved with acute or chronic gouty arthritis?
1. First metatarsophalangeal 2. Tarsal 3. Ankle 4. Knee Chapter 18 - Page 220
What are seven risk factors for the development of hip dysplasia?
1. Firstborn child 2. Frank breech presentation 3. Oligohydramnios 4. Congenital muscular torticollis 5. Metatarsus abductus 6. Congenital knee dislocation 7. Genetics (European descent, not Mendelian, increases with family members affected) Chapter 58 - Page 739
What factors are associated with poorer results with partial menisectomy of the knee?
1. Flap worse than bucket handle in returning to sports 2. Modified Outerbridge score at time of surgery- greatest factor 3. Acl instability 4. < 50 % remaining rim more progressive oa Meniscectomy as a risk factor for knee osteoarthritis: a systematic reviewBr Med Bull September 1, 2011 99 89-106
Name three symptoms of posttraumatic stress syndrome.
1. Flashbacks 2. Avoidance or phobia (places, people and experiences-remind sufferer of trauma) 3. Physical signs of hyperarousal (sleep problems, irritability, poor concentration, blackouts and difficulty remembering things) Chapter 41 - Page 541
What are five characteristics of the superficial zone of cartilage?
1. Flat chondrocyte cells 2. Collagen network is parallel to joint surface 3. Low proteoglycan content 4. Superficial chondrocytes secrete lubricin 5. Chondrocytes more flexible absence of the vimentin filaments (cytoskeleton) Chapter 3 - Page 23
What are four appropriate treatments for femur shaft fractures in patients between 7 months and 5 years old with greater than 2 cm of shortening?
1. Flexible nail 2. Plating 3. Traction to spica 4. External fixation Chapter 57 - Page 731
What are two appropriate treatments for femur shaft fractures in patients 6 years to 11 years?
1. Flexible nail for stable fractures 2. Submuscular bridge plating for unstable fractures Submuscular bridge plating Chapter 57 - Page 731
Subtrochanteric femur fractures are defined as the first 5 cm below the lesser trochanter. What are three deforming forces on the proximal fragment making it more difficult to control version?
1. Flexion 2. Abduction 3. External rotation Chapter 31 - Page 405
The biceps tendon function in shoulder stability is controversial given that one radiographic study showed superior stabilization during rotation effect while an EMG study showed no activity with shoulder motion. What two motions are proposed to have some involvement of the biceps tendon?
1. Flexion (neutral rotation) 2. Abduction (with external rotation) Chapter 24 - Page 301
What are two findings of Kirner deformity?
1. Flexion and radial deviation of the small finger at distal phalanx 2. Fingernail deformity beak- shaped and curved Chapter 55 - Page 705
What is the most common mechanism for a cervicothoracic junction injury and why it is so difficult to do a closed reduction?
1. Flexion type 2. Difficult to reduce because of steep inclination angle of facet joints of C7 and T1 Flexion-distraction injury C7-T1 Chapter 48 - Page 635
What are three interventions to minimize increased lateral pressure after lateral column lengthening (adult acquired flatfoot)
1. Fluoroscopic assessment of talonavicular reduction 2. Medial tarsometatarsal arthrodesis 3. Medial cuneiform osteotomy Chapter 40 - Page 527
What is load or stress and how is it measured?
1. Force applied to a structure 2. Load divided by area load is acting on (Unit is N/m2) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 59 Chapter 6 - Page 59
In syndesmotic injuries (where the fibula can be reduced but not maintained anatomically into the tibia incisura) what are two indications for syndesmotic fusion?
1. Fracture of Chaput tubercle 2. Comminution with loss of anterior lateral aspect of distal tibia 1: Chaput tubercle 2: Anterior inferior tibiofibular ligament Chapter 40 - Page 523
List four factors that distinguish a stable from an unstable intertrochanteric (IT) fracture pattern.
1. Fracture of the lateral wall of the grater trochanter (A2-3) 2. Extend below the lesser trochanter with loss of posterior new buttress of the calcar (A2-2) 3. Low transverse pertrochanteric (A3-3) 4. Reverse obliquity (A3-1) Chapter 31 - Page 404
What are six indications for plate fixation of tibial shaft fractures?
1. Fractures associated with articular plateau or pilon fractures 2. Periprosthetic fractures 3. Fractures in skeletally immature patients with open physes 4. Fractures initially stabilized with external fixators 5. Fractures in patients with an IM canal too small for IM nailing 6. Open fractures where wound affords access to placement of a plate Chapter 37 - Page 481
After Z-plasty releases to release the syndactyly, there is almost always a defect. Should this be closed with a partial thickness skin graft or full thickness? Harvesting can be done easily from where?
1. Full thickness skin graft 2. Volar wrist crease Chapter 55 - Page 704
Repetitive submaximal stress of joint capsule and ligaments results in a pathologic increased range of motion. The resulting atraumatic instability pattern is often associated with what four conditions?
1. Generalized laxity 2. Instability in multiple planes 3. Abnormal proprioception 4. Scapulohumeral rhythm dysfunction Chapter 24 - Page 299
What are nine risk factors for patella subluxation or dislocation?
1. Generalized soft tissue laxity 2. Increased genu valgum 3. Patella alta 4. Femoral anteversion 5. Tibial torsion 6. Trochlear dysplasia (possible genetic basis) 7. Increased quadriceps angle 8. Foot pronation 9. Patellar tilt Chapter 61 - Page 784
Name five physical findings of generalized soft tissue laxity.
1. Genu recurvatum 2. Hyperextension at elbows >10° 3. Laxity of wrist 4. Thumb opposition to forearm 5. Hyperextension of small finger A: Elbow hyperextension greater than 10°;B: Small finger hyperextensibility C.: Ability to flex thumb touching volar forearm; D.: Knee hyperextensibility; E.: Trunk flexibility Impact of Joint Laxity and Hypermobility on the Musculoskeletal System Jennifer Moriatis Wolf, J Am Acad Orthop Surg 19:463-471. Chapter 61 - Page 784
What two structural bone defects contribute to cause significant anterior instability?
1. Glenoid bone loss of 21% 2. Hill Sach lesion (because glenoid can fall into defect) Chapter 24 - Page 300
Describe the six Medical Research Council (MRC) Motor strength grading classification (0-5).
1. Grade 0 - complete paralysis 2. Grade 1 - palpable or visible contraction 3. Grade 2 - Full active range of motion with gravity eliminated 4. Grade 3 - Full active range of motion against gravity 5. Grade 4 - Full active motion against resistance 6. Grade 5 - Normal Strength Chapter 44 - Page 574
Wallerian degeneration occurs at the distal segment following nerve injury. This part of the axon is separated from its nutritional source, the neuron's cell body. This distal segment goes through a process of degeneration in preparation for regeneration of the nerve. Give four steps of Wallerian degeneration.
1. Granular disintegration of axonal cytoskeleton 2. Axonal membrane breaks apart (Neurolemma remains as a hollow tube) 3. Myelin sheath degradation by Schwann cells 4. Macrophage infiltration with clearing of debris A: Retrograde and antegrade degeneration of the axon and myelin B.: Macrophage infiltration and debris removal, Schwann cell proliferation Chapter 19 - Page 228
Leprosy (Mycobacterium leprae) is the most common cause of peripheral neuropathy in Southeast Asia, Africa, and South America. The clinical manifestation of leprosy ranges from localized disease in cooler parts of the body (face and limbs) to more widespread aggressive disease. The skin granuloma directly encases the underlying superficial nerve and can infiltrate the epineurium, perineurium, etc. During treatment with triple antibiotics there is a potential for up regulating the cellular response. What two things will happen with the skin granulomas and neuropathy?
1. Granulomatous rash worsens 2. Neuropathy worsens Chapter 19 - Page 233
In adult scoliosis, what three curve variables are affiliated with increased low back pain?
1. Greater curve magnitude and rotation 2. Loss of lumbar lordosis 3. Thoracolumbar kyphosis Chapter 45 - Page 587
Name three plain X-ray findings associated with rotator cuff tears.
1. Greater tuberosity sclerosis and excrescence (small rough prominence) 2. Subacromial spurs and or sclerosis (Sourcil sign) 3. Narrowing of the acromial humeral distance (less than 7 mm) Sourcil sign = Linear calcification in the subacromial area Chapter 24 - Page 305
What are four indications for vacuum -assisted closure dressing in a postoperative spine infection?
1. Grossly contaminated wound 2. Large area of dead space 3. Immunocompromised patient 4. Failed primary debridement and primary closure. Chapter 43 - Page 571
What are three treatments for a knee flexion contracture due to tight hamstrings in CP patients?
1. Hamstring lengthening and extension casting for 10 degree improvement 2. Femoral extension osteotomy for fixed contracture over 20 degrees 3. Correction of patella alta Chapter 63 - Page 814
What are three typical indications for temporary or definitive external fixation treatment of tibial shaft fractures?
1. Hemodynamically unstable and/or multiply injured trauma patient 2. Fractures with significant soft tissue injuries or swelling 3. Fractures in a tibia with medullary canals too small to allow use of IM nails Chapter 37 - Page 481
What two common viruses preferentially attack peripheral nerves?
1. Herpes simplex virus 2. HIV virus Chapter 19 - Page 233
Currently there is ongoing research in regard to MRI predictability of healing of OCD lesions treated conservatively (stability). Name four MRI findings suggestive of instability.
1. High T2 signal intensity cartilage fracture line 2. Surrounding cysts 3. High T2 signal intensity rim 4. Fluid-filled osteochondral defect High T2 signal intensity rim in juvenile OCD suggest instability Chapter 61- Page 791
What are two acetabular reconstruction surgical options for a Crowe III (75-100%) subluxation?
1. High center with a small cup 2. Anatomic hip center beneath a large autograft or metal augment (Severe lateral deficiency) Crowe III hip dysplasia Chapter 32 - Page 418
What four advantages are there using the antibiotic bead pouch?
1. High concentration of antibiotic in local wound (without systemic toxicity) 2. Penetrate tissues with poor vascularity 3. Prevent secondary contamination 4. Maintains aerobic environment (using semi-permeable membrane) Chapter 5 - Page 51
The elbow is susceptible to stiffness. What four factors may lead the elbow to stiffness following injury or surgery?
1. High degree of congruity of the elbow joint 2. Propensity to develop heterotopic ossification 3. Contraction of the periarticular muscle groups 4. Irritability of the ulnar nerve Chapter 27 - Page 344
What are four indications to add a femoral osteotomy to a periacetabular osteotomy for dysplasia of the hip (redirecting the head)?
1. High extrusion index 2. Abnormal femoral anteversion angles 3. Deformed femoral head 4. Radiographic signs of osteoarthritis Chapter 32 - Page 418
What are three characteristics of Sprengel's Deformity?
1. High riding scapula 2. Usually unilateral 3. Omnovertebral bar present Elevated scapula with no vertebral mass Chapter 55 - Page 706
What are four risk factors for ACL injury?
1. High risk activity 2. Female gender (landing in relative extension and valgus due to hip internal rotation) 3. Neuromuscular control of trunk and extremity 4. Size of ACL and narrow notch Chapter 35 - Page 453
What three biomechanical advantages does the double row technique have over single row repair?
1. Higher initial strength and stiffness 2. Improved footprint restoration 3. Decreased gap formation and strain Chapter 24 - Page 307
After 4-6 months, AP radiograph of the pelvis is the primary imaging modality. What are the three important lines including their location?
1. Hilgenreiner line (Horizontal) 2. Perkins line (Perpendicular at lateral roof) 3. Shenton line Yellow = Hilgenreiner, Red = Perkins, Green = Shenton Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 741 Chapter 58 - Page 741
What are four non-spine challenges of a patient with meningomyelocele?
1. Hip dysplasia 2. Clubfoot, vertical talus, calcaneovalgus deformity 3. Fractures 4. Skin ulcers over bone prominences Chapter 63 - Page 817
What are four indications for surgery in a non-ambulatory child with cerebral palsy?
1. Hip subluxation 2. Progressive scoliosis 3. Foot deformity 4. Soft tissue lengthening to improve standing, transferring, sitting or shoe wear Chapter 63 - Page 815
The older patients with thoracic kyphosis and decrease lumbar who maintain their sagittal balances are able to compensate with their hips and knees in what two ways?
1. Hips in extension and pelvic retroversion 2. Knee flexion Chapter 45 - Page 589
Reconstruction techniques for medial collateral ligament include figure-of-eight, docking techniques, Endobutton and interference screws with single or double-strand tendon graft. Recent biomechanical study revealed which two are the strongest?
1. Humeral docking 2. Endobutton None were as strong as native ligament Chapter 27 - Page 348
What are three indications for humeral head replacement in chronic posterior shoulder dislocations?
1. Humeral head severely osteoporotic with collapse 2. Severe arthritis of the humeral head 3. Bone loss greater than 50% of articular surface Chapter 24 - Page 303
Nonaccidental trauma accounts for 50-69% of all fractures in children younger than 1 year. Which two long bones are most commonly fractured in child abuse?
1. Humerus is most common 2. Femur is second most common Chapter 57 - Page 731
This diagnosis of radioulnar synostosis is frequently missed because the child is able to compensate for the limited range of motion. What are two areas of the upper extremity in which the child can compensate?
1. Hyper rotation of the wrist (more than 100°) 2. Rotation of the shoulder Chapter 55 - Page 706
Classification and treatment of bunions are dependent on the measurement of the intermetatarsal angle and the hallux valgus angle. What are normal values for the IMA and HVA?
1. IMA <9° 2. HVA <15° (Distal metatarsal articular angle <10°, hallux interphalangeal angle <10°) Chapter 40 - Page 526
What are seven causes of fixed sagittal imbalance?
1. Iatrogenic a. Fusion in hypolordosis b.. Proximal junctional kyphosis (above a fused segment) 2. Ankylosing spondylitis 3. Congenital kyphosis 4. Posttraumatic conditions 5. Osteoporotic compression fractures 6. Infection 7. Neoplasm Chapter 45 - Page 589
Smith - Petersen osteotomy is not successful in which two situations?
1. If anterior fusion is present 2. If there is minimal disc height with large osteophytes Smith-Petersen osteotomy-posterior column resection Chapter 45 - Page 590
What four best methods can be used by a practicing orthopedic surgeon to determine generalizability of a study?
1. If their personal patients would be included in the study 2. Evaluating inclusion and exclusions 3. The importance of the specific outcomes to their patients 4. Do the outcomes fit their patients values and preferences (i.e. early weightbearing versus decreased need for blood transfusions) Chapter 15 - Page 175
Pelvic apophysitis can occur in what three areas in young athletes?
1. Iliac crest 2. Ischial tuberosity 3. Lesser tuberosity Apophysitis injury at ischium and lesser tuberosity Chapter 61- Page 794
What two benefits are there with the addition of intrathecal ketamine to bupivacaine for continuous epidural with the initial surgery (amputation)?
1. Immediately postop less pain 2. Decreased depression and anxiety(NMDA receptor antagonist effect of ketamine) (Rates of stump and phantom pain up to 1 year-no difference) Chapter 41 - Page 541
What are two advantages of CT scan in imaging of the spine with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis?
1. In patients with ankylosing spondylitis, severe osteoporosis makes detection of fractures more reliable with CT scan 2. In patients with diffuse idiopathic skeletal hyperostosis, the rigidity of the spine usually causes a transversely-oriented fracture affecting all 3 columns, and is better evaluated on CT scan A, Cross-table lateral radiograph of the cervical spine of a 49-year-old man with known ankylosing spondylitis who was involved in a motor vehicle crash shows extensive bony fusion of the spine. No fracture is seen. B, Sagittal reformatted CT image shows a nondisplaced fracture at the C5-C6 level (arrow). Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 91 Chapter 8 - Pages 90-91
List four complications associated with posterior cervical spine surgery when dealing lower cervical spine trauma?
1. Increased bleeding 2. More wound healing complications 3. Prolonged incisional pain 4. Decreased neurologic improvement compared to anterior surgery (70% improved at least 1 Frankel score with anterior surgery and 57% with posterior surgery) Grade A Complete neurological injury - no motor or sensory function clinically detected below the level of the injury. Grade B Preserved sensation only - no motor function clinically detected below the level of the injury; sensory function remains below the level of the injurybut may include only partial function (sacral sparing qualifies as preserved sensation). Grade C Preserved motor non-functional - some motor function observed below the level of the injury, but is of no practical use to the patient. Grade D Preserved motor function - useful motor function below the level of the injury; patient can move lower limbs and walk with or without aid, but does not have a normal gait or strength in all motor groups. Grade E Normal motor - no clinically detected abnormality in motor or sensory function with normal sphincter function; abnormal reflexes and subjective sensory abnormalities may be present. Frankel Score Chapter 48 - Page 631
What are three radiographic characteristics of osteoarthritis (OA)?
1. Increased bone mineralization or subchondral sclerosis of the hip and knee 2. Osteophyte formation 3. Non-uniform joint space narrowing Chapter 8 - Page 85
What is the typical MRI with intra-articular contrast findings with multidirectional instability?
1. Increased capsular volume 2. No labral tears Increased volume of capsule with multidirectional instability Chapter 24 - Page 303
There are concerns of flexing the elbow to 120° in maintaining a reduction of a supracondylar humerus fracture. What two findings have been found when flexing the elbow past 90° with acute supracondylar humerus fractures?
1. Increased forearm compartment pressure 2. Loss of radial pulse Chapter 53 - Page 678
What five conditions happen as the anulus fibrosis ages?
1. Increased load on the annulus fibrosis (loss of hydrostatic pressure of the nucleus pulposus) 2. Structural damage such as delamination, anulus tears, prolapse, herniation, and end plate fracture may occur 3. Disc space narrowing 4. Radial bulging (lack of hydrostatic pressure of nucleus pulposus) 5. End plate fractures Chapter 3 - Page 29
What are two physical findings of multidirectional instability?
1. Increased motion in multiple planes compared to contralateral side 2. Provocative test for anterior, posterior and/or inferior instability Positive sulcus sign Chapter 24 - Page 303
What are two advantages of having a myelinating Schwann cell associated with the axon?
1. Increased speed of action potential (fast) 2. Allows signal to reach target on timely basis (efficient) Myelinating neuron (1 to 1 relationship between Schwann cell and myelin) Chapter 19 - Page 225
List three non-surgical treatment algorithms for a spinal infection.
1. Infectious disease consultation 2. Obtain cultures 3. Parenteral antibiotics tailored to the organism for 2-6 weeks followed by oral therapy Chapter 43 - Page 569
The normal oxygen tension in cartilage is 2% to 10% (relatively low considering other tissues). What three effects on cartilage are associated with very low oxygen levels (less than 1%)?
1. Inhibition of glycolysis 2. Reduced ATP levels 3. Vascular invasion of the tidemark (across the calcified cartilage)via VEGF expression (Intra-articular hypoxemia accompanies osteoarthritis and joint inflammation) Chapter 3 - Page 24
Apophyseal avulsion injuries of the pelvis are caused by sudden muscle contraction and the athlete feels a "pop" followed by immediate pain and weakness. Name five apophyseal avulsion injuries of the pelvis.
1. Initial tuberosity-hamstrings 2. Anterior superior iliac spine-tensor fascia lata 3. Lesser trochanter-iliopsoas 4. Pubis-adductors 5. Anterior inferior iliac spine-rectus femoris 6. Iliac crest-gluteus medius Chapter 61 - Page 788
What two injuries underlies posterolateral rotatory instability?
1. Injury to the LCL (specifically the lateral ulnar collateral ligament [LUCL]) complex. i. Mechanism is supination, axial loading, valgus stress, and extension of the elbow. ii. Radial head subluxtes posterior to capitellum and rotation of the semilunar notch away from the trochlea. 2. Iatrogenic: after lateral epicondylar release Chapter 27 - Page 345
What is the most common specific injury resulting in symptomatic posterior lateral rotary instability?
1. Injury to the LCL complex specifically the lateral ulnar collateral ligament (LUCL) Chapter 27 - Page 345
What are two concerns of unilateral or bilateral facetectomy or laminectomy (extensive) especially with adult scoliosis?
1. Instability 2. Progression of curve Chapter 45 - Page 589
What are four requirements for a latissimus dorsi tendon transfer for irreparable rotator cuff tears?
1. Intact subscapularis 2. Irreparable posterior superior tear 3. External rotation deficit 4. Grade 2 or less fatty infiltration of teres minor (other authors-improve results with teres minor dysfunction) Chapter 24 - Page 308
What are two ways to analyze randomized study groups who are receiving different treatments?
1. Intention-to-treat analysis 2. Per-protocol analysis Chapter 15 - Page 175
What are four procedures used to fix sagittal imbalance?
1. Interbody fusion 2. Smith-Petersen osteotomy 3. Pedicle subtraction osteotomy 4. Vertebral column resection Chapter 45 - Page 590
Which two initial inflammatory cytokines are produced in large amounts by chondrocytes in osteoarthritis?
1. Interleukin-1 beta 2. Tumor necrosis factor-alpha Chapter 18 - Page 213
Name the three patterns of Lyme arthritis.
1. Intermittent mono- or oligoarthritis of knee or large joints (50%) 2. Waxing and waning arthralgia (20%) 3. Chronic inflammatory arthritis with joint destruction (10%) Chapter 18 - Page 221
Multifocal motor neuropathy usually presents with what three patterns of weakness?
1. Intrinsic hand weakness 2. Wrist drop 3. Foot drop NB: No sensory complaints or findings Chapter 19 - Page 233
Fixed equinus contractures treated in the past with a Z-lengthening can result in postoperative weakness given that this releases both the gastrocnemius and soleus muscles. What two preferred procedures have less of a chance of this complication given that they preserve soleus muscle power
1. Isolated gastrocnemius lengthening (Strayer)-resection of gastrocnemius fascia 3 cm proximal to the gastrocnemius soleus aponeurosis 2. Intramuscular fascial lengthening (Vulpius) Surface anatomy showing where releases are done for equinus. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 815 Chapter 63 - Page 815
Muscle weakness accompanies osteoarthritis and increasing muscle strengthening helps reduce the load on the articular cartilage. What type of exercise is best for an arthritic joint and why?
1. Isometric exercises 2. Less stress on joint compared to isotonic Chapter 18 - Page 216
What are three options in postoperative dressings for amputation?
1. It is thought that early weight bearing may improve early wound healing, but this is not well established 2. Prevention of contractures and decreased edema are primary objectives 3. As the incision heals, elastic wraps or shrinker socks control swelling and shape stump Elastic bandaging technique Chapter 41 - Page 539
What are six static stabilizers of the shoulder joint?
1. Joint congruency 2. Capsulolabral complex including: labrum glenohumeral ligaments coracohumeral ligament 3. Coracoacromial ligament 4. Negative intra-articular pressure 5. Synovial fluid Adhesion-cohesion 6. Rotator cuff Anterior glenohumeral ligaments Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 300 Chapter 24 - Page 299
What two things are significant about a posterior horn medial meniscus tear?
1. Joint contact pressures are equivalent to a total medial menisectomy 2. Repair will restore value to normal Chapter 35 - Page 459
What are four radiographic characteristics of hypertrophic neuropathic arthropathy?
1. Joint destruction 2. Joint dislocations 3. Bone debris formation 4. Excessive bone formation Charcot joint, hypertrophic neuropathic arthropathy Chapter 8 - Page 87
What are the three most common sources of pain in OA?
1. Joint effusion 2. Synovial hypertrophy 3. Bone marrow edema Chapter 18 - Page 215
What are four classic radiographically findings of OA?
1. Joint-space narrowing 2. Osteophytes 3. Subchondral sclerosis 4. Subchondral bone cysts (geodes) Chapter 18 - Page 216
Reactive arthritis (aka Reiter syndrome,Post- Infectious Arthritis) typically involves which three anatomic areas?
1. Joints 2. Urethra (urethritis) 3. Eyes (conjunctivitis) (There may also be ulcers of the skin at palms and sole and mucous membrane ulcers) A.D.A.M. Medical Encyclopedia. at PubMedReactive arthritis Reiter syndrome; Post-infectious arthritis
The high molecular weight proteoglycan are aggregates of hyaluronic acid which are heavily populated with what two sulfated glycosaminoglycans?
1. Keratin 2. Chondroitin sulfate These aggregates our entrapped within the collagen fibril network and are negatively charged interacting with water through hydrogen bonds. 80% of the proteoglycans of cartilage are these large matrix aggregates made up of a hyaluronic acid chain with core protein and glycosaminoglycan (keratin and chondroitin sulfate) Chapter 3 - Page 23
Randomized control trials provide the best quality of evidence where patients are randomly allocated to control and experimental groups. The strength of these experimental studies is determined by the "balance at baseline". The "balance at baseline" is defined as the balance of what two groups of factors (prognostic and confounding) that are balance between the control and experimental group?
1. Known prognostic or confounding factors (age, gender, weight, comorbidities, etc.) 2. Unknown prognostic or compounding factors ((compliance, genetics, socioeconomics, etc.) Example of confounding factor Chapter 15 - Page 168
What are five key lower extremity motor exams to determine the lumbar spine neurologic level?
1. L2: Hip flexion 2. L3: Knee extension 3. L4: Ankle dorsiflexion 4. L5: Great toe extension 5. S1: Ankle plantar flexion Chapter 44 - Page 574
What are three indications for surgical reduction of the hip in meningomyelocele?
1. L3 motor level or lower (good quadriceps function) 2. Unilateral dislocation 3. Community ambulator Chapter 63 - Page 817
Give five indications to extend the caudad fusion to S1 in adult scoliosis surgery.
1. L5-S1 spondylolisthesis 2. L5-S1 stenosis 3. Oblique takeoff of the L5 4. Prior L5-S1 laminectomy 5. Severe L5-S1 disc degeneration Chapter 45 - Page 588
What four agents are recommended for VTE prophylaxis for patients undergoing an elective THA or TKA and an elevated risk of PE, but standard bleeding risk?
1. LMWH 2. Fondaparinux 3. Warfarin (INR less than 2) (not ASA) 4. Consider mechanical prophylaxis, rapid post op mobilization and patient education of the symptoms of VTE as well. Chapter 12 - Page 141
Diluted gadolinium (1:100) is used intra-articularly looking for what three pathologies?
1. Labral tears 2. Recurrent meniscal tears 3. Cartilage defects Chapter 8 - Pages 95-96
What are four advantages of a finite element analysis compared to laboratory experiments?
1. Larger variety of results, e.g., strain, stress and deformation can be determined in every location of the model 2. Model geometry, material properties and boundary conditions can be changed 3. Different loading scenarios can be tested 4. Measurements from inside the model Chapter 6 - Page 69
When performing posterior cervical instrumentation, what are two implants of choice along the cervical spine?
1. Lateral mass screws are the implants of choice between C3 through C6 2. Pedicle screw fixation is the implant of choice at C2, C7, and the upper thoracic segments A. = C4-5 bilateral jumped facets; B. and C. = lateral mass screw fixation Chapter 48 - Page 632
What are two X-ray findings during the fragmentation phase relate to poor prognosis?
1. Lateral subluxation 2. Hinge abduction Bilateral Legg-Calve-Perthes disease showing right hip lateral subluxation and hinge abduction (AP pelvis with hips abducted) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 746 Chapter 58 - Page 746
What three inter-trochanteric hip fracture patterns have a higher failure rate when treated with a sliding hip screw?
1. Lateral wall fracture 2. Reverse obliquity 3. Low transverse fractures Chapter 31 - Page 405
Microfracture or micro-drilling are indicated for stage II and stage III osteochondral lesions of the talus of what size?
1. Less than 6 mm 2. Greater than 15 mm the efficacy of microfracture and micro-drilling is questionable Chapter 40 - Page 526
What are three disadvantages of knee disarticulation versus transfemoral?
1. Limitations of knee joint prosthetic components 2. Asymmetry of knee joint with sitting and gait 3. Patients with soft tissue trauma around the knee may be unable to accommodate the distal-end weight bearing and have decreased level of function Chapter 41 - Page 538
Name three risks or disadvantages of the anterior medial or medial approachs for hip dysplasia.
1. Limited ability to perform capsulorrhaphy 2. Osteonecrosis 3. Upper femoral growth disturbances Chapter 58 - Page 742
Pelvic incidence is an angle between what two lines?
1. Line perpendicular to the sacral endplate 2. Line joining between the middle of the sacral endplate and center of the bicoxofemoral axis (center of the head) Chapter 45 - Page 589
What are the six most important factors in managing extremity wounds to prevent infection?
1. Location of the wound 2. Amount of soft tissue injury 3. Strength of the bacteria producing the infection 4. Condition of the host 5. Amount of foreign material entrapped in the wound 6. Timing of the treatment by admission to a definitive trauma center Chapter 5 - Page 49
Phocomelia resulted in the past from Thalidomide used to treat nausea during pregnancy. What category of congential defects does it belong to?
1. Longitudinal deficiency with intercalary aplasia of the the forearm segment or entire arm or leg 2. Flipper like appearance of hands or feet Chapter 55 - Page 704
What four pathologic conditions can affect the peroneal tendon sheath?
1. Longitudinal splits of the tendons 2. Tendon dislocations or subluxations 3. Accessory peroneal tendons 4. Distal peroneus brevis muscle belly creating a space occupying lesion Chapter 40 - Page 528
Some studies in regard to acute first-time patella dislocation suggest immediate surgery. What may be some indications?
1. Loose bodies 2. Residual lateral tilting or subluxation of the patella indicating early MPFL repair Chapter 35 - Page 461
What are three outcomes of disruption of the transverse force couple?
1. Loss of concavity compression 2. Pathologic increase in translation or subluxation 3. Decreased active abduction (diminished function) Chapter 24 - Page 301
Of the radiographic parameters, which three best correlated with the HRQL (health-related quality of life) outcomes survey?
1. Loss of lumbar lordosis 2. Coronal imbalance greater than 5 cm 3. Increased lateral listhesis greater than 6 mm (Not by curve magnitude) C7 PL = C7 plumb line Chapter 45 - Page 587
List the four diagnostic criteria for Ankylosing Spondylitis (AS).
1. Low back pain lasting at least 3 months not remedied by rest and made better with exercise 2. Decreased lumbar spine ROM in sagittal and frontal planes 3. Diminished chest expansion when compared to peers of similar age and sex 4A. Grade 3 or 4 unilateral sacroiliitis 4B. Grade 2, 3 or 4 bilateral sacroiliitis AS is confirmed if 4A or 4B is accompanied by any of 1, 2 or 3. Photo shows a patient with Ankylosing Spondylitis. Chapter 18 - Page 219
After age 40, what are three frequently reported symptoms in adult scoliosis?
1. Low back pain, 2. Radicular leg pain 3. Neurogenic claudication Chapter 45 - Page 585
What four advantages are there with the transosseous and transosseous equivalent rotator cuff repair techniques?
1. Low bone-tendon interface motion 2. Excellent footprint restoration 3. High number of cycles to failure 4. Favorable distribution of stress over the repair Transosseous equivalent rotator cuff repair (Suture Bridge) Chapter 24 - Page 307
What are two advantages of knee disarticulation over transfemoral amputation?
1. Lower energy expenditure during walking 2. End bearing residual limb Level of amputation and energy expenditure and speed Chapter 41 - Page 538
What region of the spine is most affected by vertebral osteomyelitis?
1. Lumbar spine (50%) 2. Thoracic 3. Cervical (5%) Chapter 43 - Page 565
Name sixteen risk factors for avascular necrosis of the hip.
1. Lupus 2. Injury 3. Gaucher 4. HIV 5. Transplant 6. Steroid 7. Caisson 8. Radiation 9. Alcohol 10. Pancreatitis 11. Endocarditis 12. Sickle cell 13. Rheumatoid Arthritis 14. Idiopathic 15. Blood Clotting Disorders 16. Smoking Acronym: LIGHT SCRAPES RIBS Chapter 32 - Page 419
The diagnostic yield in needle biopsies (false-negative later positive on open biopsy) is higher in what three types of lesions?
1. Lytic greater than sclerotic 2. Larger lesions 3. Increased core lengths (Non-diagnostic cores tend to occur in benign lesions) Chapter 8 - Page 102
Cartilage osteoarthritis results from cartilage destruction from what two main enzyme families?
1. MMPs( a Matrix Metalloproteinases) responsible for cartilage collagen breakdown, 2. ADAMTS (a disintegrin and Metalloproteinase domain with thrombospondin motifs) family mediate cartilage aggrecan loss Chapter 3 - Page 25
Comparing intramedullary nailing versus plate fixation in distal tibia fractures (4-11 cm from plafond) indicated that IM nailing had a higher risk of what two bad outcomes?
1. Malunion 2. Non Union Chapter 37- Page 483
What are the two primary complications associated with functional bracing of the tibial shaft?
1. Malunion 2. Shortening Chapter 37 - Page 481
In complex syndactyly, what two challenges make surgery more difficult?
1. May require soft tissue transfer to reconstruct lateral nail fold 2. Digital neurovascular bundles may be abnormal or absent Chapter 55 - Page 704
What are three trauma management principles for acute cervical spine trauma?
1. Mean arterial pressure greater than 85 mmHg (avoid second-shock trauma to cord) 2. Hematocrit greater than 30% 3. Adequate oxygenation with atraumatic airway management Chapter 48 - Page 627
List five main causes for post-operative residual limb pain.
1. Mechanical 2. Neuroma 3. Ischemic 4. Infection 5. Neuropathic-RSD/CRPS Chapter 41 - Page 541
Thrower's elbow is a group of overuse syndromes that results from repetitive microtrauma of the immature elbow. What are three areas of thrower's elbow?
1. Medial (tension) 2. Lateral overload (compression) 3. Posterior (shearing) 3 mechanisms of thrower's elbow Chapter 61 - Page 789
What are two common misdiagnoses made in place of valgus instability?
1. Medial epicondylitis 2. Inflamed cubital tunnel Chapter 27 - Page 346
What are two restraints against patellar dislocation (lateral)?
1. Medial patellofemoral ligament (MPFL) 2. Medial retinaculum. The MPFL is the primary soft tissue structure preventing lateral dislocation of the patella. Chapter 61 - Page 784
When doing ACL reconstruction with trans-physeal reconstruction in a Tanner 3 or greater, what are two modifications from the usual procedure used in adults?
1. Metaphyseal fixation without injury to the physes 2. Autogenous hamstring rather than patellar bone tendon bone grafts Chapter 61 - Page 786
Name five disease modifying anti-rheumatic drugs.
1. Methotrexate 2. Sulfasalazine 3. Leflunamide 4. Hydroxychloroquine 5. Minocycline Chapter 18 - Pages 217-218
Although not clinically proven, what are five roles of magnesium in SCI?
1. Mg is a physiologic N-methyl-D-aparate (NMDA) receptor antagonist 2. Glutamine levels rise after SCI and act to over stimulate the NMDA receptors 3. Leads to a massive influx of Ca, leading to cell death. 4. Mg dosing so far exceeds human safety recommended doses 5. Magnesium combined with polyethylene glycol has allowed lower doses of magnesium Human studies are now ongoing Chapter 44 - Page 578
What are three surgical options for focal defects < 2 cm?
1. Microfracture, 2. ACI (Autologous Chondrocyte Implantation) 3. OATS (Osteochondral Autograft Transfer System) Chapter 35 - Page 460
List three grades of severity for bunion deformity, including HVA and IMA.
1. Mild (HVA <30º, IMA <13º) 2. Moderate (HVA<40º, IMA 13°-20°) 3. Severe (HVA >40º, IMA >20°) Chapter 40- Page 526
What is the best approach to a subtrochanteric femur fracture that cannot be reduced via closed means?
1. Mini approach 2. Minimal periosteal stripping 3. Avoid =overtightening of cables Chapter 31 - Page 405
What are the five advantages of using negative pressure wound management to cover split thickness skin grafts?
1. Minimize shear forces 2. Decrease wound bed edema 3. Hinder infection 4. Increases the conformity of the skin graft on uneven surfaces 5. Allows faster healing of the donor site Chapter 5 - Page 52
Most odontoid fractures are treated non-surgically. Type I are rare and should be evaluated for craniocervical dissociation. Type III heals well with external immobilization after closed reduction. What are five parameters for-Type II fractures to be treated non-surgically?
1. Minimum fracture translation 2. Minimum fracture angulation 3. Absence of comminution 4. No nicotine usage 5. No other cervical spine abnormalities Chapter 48 - Page 630
What is the rationale in using Minocycline in therapy for spinal cord injury patients?
1. Minocycline is a tetracycline antibiotic with anti-inflammatory and antiapoptotic properties. 2. Since inflammatory response is a contributory factor in secondary damage 3. The ability to prevent release of proinflammatory mediators from microglial (CNS macrophages) activation have shown effectiveness in animal models. Chapter 44 - Pages 576-577
What is the initial treatment for an acute anterior shoulder dislocation following closed reduction?
1. Mobilization in external rotation to reduce labrum (controversial) 2. Physical therapy to regain strength and range of motion Chapter 61 - Page 788
What are three advantages of CT scan in imaging of tibial plateau fractures?
1. More accurate classification of tibial plateau fractures is possible, which can affect treatment recommendations 2. More accurate assessment of the amount of fracture comminution is possible 3. More accurate assessment of joint depression is possible Chapter 8 - Page 92
In regards to imaging of the cervical spine to rule out a fracture, what are two advantages of CT scan over plain radiography?
1. More cost effective in patients at moderate or high risk for fracture 2. More accurate in identifying fractures Chapter 8 - Page 85
What are two advantages of intrathecal baclofen over oral administration?
1. More effective in reducing tone (spasticity) 2. No effect on cognitive capacity Chapter 63 - Page 812
What are the two most common causes for a femoral shaft fracture in children > 10?
1. Motor vehicle accident 2. Motor vehicle vs. Pedestrian (Cortical thickness increases with age therefore mechanism of injury correlates with age) Chapter 57 - Page 731
What are the two most common causes of pediatric pelvic ring fractures?
1. Motor vehicle accident 2. Motor vehicle vs. Pedestrian Chapter 57 - Page 727
Name five diseases that should be considered when diagnosing bilateral (simultaneous LCP disease).
1. Multiple epiphyseal dysplasia 2. Spondyloepiphyseal dysplasia 3. Sickle cell disease 4. Gaucher disease 5. Hypothyroidism Chapter 58 - Page 743
What five conditions must be ruled out with Legg-Calve-Perthes disease?
1. Multiple epiphyseal dysplasia 2. Spondyloepiphyseal dysplasia 3. Sickle cell disease 4. Gaucher disease 5. Hypothyroidism Chapter 58 - Page 745
What are three clinical signs that can be seen in a patient with osteogenesis imperfecta?
1. Multiple fractures 2. Blue Sclera 3. Hearing loss Dentinogenesis imperfects Chapter 57 - Page 731
With complex regional pain syndrome (reflex sympathetic dystrophy) of the anterior knee, what are three physical findings?
1. Muscle atrophy 2. Skin abnormalities (stage I: Increased hair and vasospasm with change in temperature and color; stage II: Diminished hair and swelling) 3. Allodynia (pain from stimulus that normally does not provoke pain) Complex regional pain syndrome of the left knee (swelling, color change) Chapter 61 - Page 790
What are two general considerations with abnormal insertional activity or spontaneous baseline electrical activity?
1. Muscle damage 2. Nerve damage Chapter 19 - Page 230
The EMG test is helpful in which four general categories of disorders?
1. Muscle disease 2. Primary disease of the nerve roots 3. Peripheral nerves disorders 4. Acute versus chronic nerve lesion
Immunocompromised patients and patients in the underdeveloped world are more likely to experience spinal infections by which three types of nonpyogenic bacteria?
1. Mycobacteriae 2. Brucella species 3. Fungi Chapter 43 - Page 565
Which two organisms are associated with subacute or chronic monoarticular septic arthritis?
1. Mycobacterial 2. Fungal Chapter 18 - Pages 220-221
In the peripheral nervous system, the nerves are made up of bundles of axons and their associated Schwann cells. What are two subtypes of Schwann cells?
1. Myelinating (large-caliber axons) 2. Non-myelinating (small-caliber C fibers transmitting pain and temperature) Chapter 19 - Page 225
What changes are seen with peripheral neuropathy with myelinating and non-myelinating nerves?
1. Myelinating-loss of demyelination 2. Non-myelinating-change in Remak bundles Chapter 19 - Page 225
Charcot-Marie-Tooth disease is a group of inherited motor sensory neuropathies with more than 30 gene mutations. Name four nerve functions that may be altered by one of these gene mutations.
1. Myelination 2. Axonal transport 3. Schwann cell differentiation 4. Nerve cell function Chapter 63 - Page 819
List four nonsurgical treatment options for ankylosing spondylitis.
1. NSAIDS 2. Sulfasalazine (2nd line) 3. TNF-alpha blockers (expensive, adverse side effects) 4. Physical Therapy (spinal extension program) Chapter 18 - Page 219
What are two initial treatments for adult acquired flatfoot deformity and posterior tibial tendon dysfunction?
1. NSAIDs 2. Immobilization Chapter 40 - Page 527
What are two treatment options for pseudogout?
1. NSAIDs 2. Intra-articular glucocorticoids Chapter 18 - Page 220
Name six risk factors for DDH (Developmental Dysplasia of the Hip).
1. Native Americans and Laplanders 2. First-degree relative with DDH (12-fold increase) 3. Female (80%)-perinatal ligamentous laxity + maternal hormones 4. Swaddling, improper with hips extended 5. Breech position during the 3rd trimester 6. Left hip (left = 60%, right = 20%, bilateral = 20%) 1. Traditional improper swaddling with hips extended associated with increased risk of hip dysplasia; 2. Straddle position = diminished risk of dysplasia; 3. Contemporary swaddling allowing flexion of the hips and knees = diminished risk of dysplasia Chapter 58 - Page 739
What are four limitations of the use of Warfarin for the prevention of Venous Thromboembolic Disease (VTE)?
1. Need for blood draws for dosing 2. Interaction with some drugs and foods 3. Variable genetic lead based metabolism 4. Long and half-life therefore time for reversing effects (Warfarin is an oral drug that is a vitamin K antagonist.). Chapter 12 - Page 138
Post diskectomy diskitis without disc space abscess can be treated with what three treatment algorithms?
1. Needle biopsy for pathogen 2. Intravenous antibiotics 3. If abscess formation, intractable pain, instability or deformity than surgery Chapter 43 - Page 571
What are two differences between neurogenic and spinal shock?
1. Neurogenic shock is hypotension and bradycardia from disruption of sympathetic outflow 2. Spinal shock is the absence of spinal reflexes that occurs after a severe spinal cord injury Chapter 44 - Page 573
Where are two serious risk factors for epidural abscess?
1. Neurologic demise 2. Death Chapter 43 - Page 570
List three inhibitory molecules contained within myelin that block axonal regrowth that are currently being targeted in the treatment of acute spinal cord injury.
1. Nogo 2. Myelin-associated glycoprotein (MAG) 3. Oligodendrocyte myelin glycoprotein (OMgp) Chapter 44 - Page 576
The four most common long term complications are there from >1cm of pelvic asymmetry?
1. Non structural scoliosis 2. Lumbar pain 3. Sacroiliac joint paint 4. Trendelenburg sign Chapter 57 - Page 727
What are four treatment options for flexion-teardrop fracture?
1. Nonsurgical (Halo vest)-quality of life outcome less favorable compared to anterior surgical 2. Anterior surgical (anterior corpectomy, strut grafting with plating-good outcome) 3. Posterior surgical 4. Combined anterior-posterior (poor bone quality) Chapter 48 - Page 634
Are Beta-catenin concentrations high or low in normal and arthritic cartilage?
1. Normal cartilage-low concentrations of Beta-catenin 2. Arthritic cartilage-high concentrations of Beta-catenin Takahito Yuasa et al. Laboratory Investigation (2008) 88, 264-274; doi:10.1038/labinvest.3700747; published online 28 January 2008
Femoral neck fractures after hip resurfacing are associated with which two technical factors?
1. Notching of the femoral neck 2. Varus positioning of the femoral component Notching with hip resurfacing Chapter 32 - Page 423
What three changes occur during disk development?
1. Notochordal cells are replaced by chondrocyte-like cells 2. End plates become thinner and narrower 3. Nucleus becomes more similar to inner anulus Chapter 3 - Page 29
What six patient factors increase the risk of spinal postoperative infections?
1. Obesity 2. Smoking 3. Diabetes 4. Alcohol abuse 5. Malnutrition 6. Chronic steroid use Chapter 43 - Page 570
What two fixation options are available for unstable radial neck fracture after reduction?
1. Obliquely directed wires 2. Retrograde intramedullary rod (can also be used for reduction) Chapter 53 - Pages 682
What are the three indications for measuring intracompartmental pressures to assist in the diagnosis of compartment syndrome in the presence of tibial shaft fracture?
1. Obtunded patient 2. Pediatric patient 3. Presence of neurologic impairment Clinical examination findings suspicious but equivocal Chapter 37 - Page 479
What are four indications of limited decompression and fusion and adult scoliosis?
1. Older 2. Unilateral or bilateral leg symptoms 3. Lumbar stenosis 4. Minimal or no back pain Chapter 45 - Page 589
What are three poor prognostic factors for LCP disease?
1. Older age of onset (> 6 years) 2. Type B/C or C (Lateral Pillar Classification) hips with an onset at 4-5 years 3. Lateral subluxation/hinge abduction (deformity prevents abduction Drawings showing the Herring lateral pillar classification of LCP disease Chapter 58 - Page 745
What are three relative contraindications for centralization procedures in radial longitudinal deficiencies?
1. Older patient who has functionally compensated 2.Patient with a proximate terminal condition 3.Patient with an extension contracture of the elbow who relies on the radial deviation to reach the mouth Highbred slowly correcting wrist position with soft tissue balance before surgical centralization of radial deficiency Chapter 55 - Page 700
Thrower's elbow with posterior elbow pain may have what three X-ray findings?
1. Olecranon apophysitis 2. Avulsion fracture of the olecranon apophysis 3. Delay of the apophyseal closure of the olecranon apophysis Chapter 61 - Page 790
Surgical approaches to multidirectional instability depends on the direction of the instability. Name two surgical approaches.
1. Open capsular shift i.e. inferior capsular shift- 88% success rate 2. Arthroscopic plication-85-88% success rate (early results T-capsule inferior capsular shift for multidirectional instability Chapter 24 - Page 303
What are two recommended procedures for 25% -30% loss of the anterior glenoid bone with shoulder dislocation?
1. Open or arthroscopic coracoid transfer procedure 2. Structural iliac crest bone graft (4.4% recurrence with Laterjet procedure) Photo displays Latarjet repair procedure. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 302 Chapter 24 - Page 302
Adolescents with Neer-Horowitz type III and IV proximal humerus fractures can be treated with what surgical treatment options?
1. Open reduction and fixation with retrograde flexible nails 2. Closed treatment of severely displaced and angulated proximal humerus fractures (most studies have reported good functional results) Chapter 53 - Page 676
What are four goals of preoperative amputation evaluations?
1. Optimize medical co-morbidities 2. Prevent contractures 3. Balance and transfer training 4. Strengthening and endurance exercises Chapter 41 - Page 537
The mortality rate following a hip fracture in elderly patients is 25% in the first year. One third of men and one half of woman will have a fragility fracture during their lifetime. Name three ways that orthopaedic surgeons can positively impact these statistics?
1. Orthopaedic surgeons identifying and managing patients with osteoporosis 2. Osteoporosis treatment can be initiated by orthopaedic surgeons at the time of admission for hip or other fragility fractures. 3. AAOS "Own The Bone" Initiative (improve communication with patients who have had hip fractures and primary care physicians) Chapter 31 - Page 406
Name the two most useful procedures to detect hip instability in a newborn.
1. Ortolani = palpable reduction of a displaced hip in the flexed/abducted position. 2. Barlow = subluxation of the hip with posterior force on a flexed/adducted thigh Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 740 Ortolani and Barlow signs are rarely present after 3 months of age Chapter 58 - Page 739
What are five potential causes for posterior ankle impingement syndrome?
1. Os trigonum impingement (most common) 2. Os trigonum fracture 3. Flexor hallucis longus tenosynovitus 4. Ankle osteochondritis 5. Subtalar joint disease Posterior Ankle Impingement Syndrome • Javier Maquirriain J Am Acad Orthop Surg October 2005; 13:365-371
What three options are used to treat large Hill-Sach lesions (> 25% of joint surface)?
1. Osteochondral allograft 2. Infraspinatus transfer 3. Remplissage (arthroscopic capsulotenodesis posterior capsule and infraspinatus into Hill-Sachs defect) Remplissage combined with a Bankart repair Chapter 24 - Page 302
What are two surgical options for focal defects > 2 cm?
1. Osteochondral transfer 2. ACI Chapter 35 - Page 460
What are six complications that can result in the treatment of slipped capital femoral epiphysis?
1. Osteonecrosis 2. Chondrolysis 3. Slip progression 4. Pin related femur fracture 5. Screw impingement 6. Upper femoral deformity with resultant functional limitations Upper femoral deformity with retroversion following slipped capital femoral epiphysis, Chapter 58 - Page 747
What are 2 less frequent complications of pediatric subtrochanteric femur fractures?
1. Osteonecrosis 2. Heterotopic ossification Chapter 57 - Page 729
What are four additional risks of acute cervical spine injuries in the elderly population?
1. Osteopenia with fixation failure (short-segment fixation not appropriate) 2. Aspiration pneumonia 3. Intolerance to external immobilization devices 4. Need for anticoagulation for comorbidities Chapter 48 - Page 636
What are two nonoperative management of valgus instability?
1. PT for strengthening of flexor-pronator muscles 2. Rest from throwing for at least 6 weeks, then resume throwing if attention to throwing mechanics. (Study: 13 of 31 of throwing athletes treated nonsurgically return to preinjury level) Chapter 27 - Page 347
What are two common patient complaints with posterolateral rotatory instability?
1. Pain 2. Catching or clunking when pushing off from the arm of a chair. Chapter 27 - Page 345
What are three common symptoms associated with valgus instability?
1. Pain 2. Loss of throwing velocity 3. Loss of throwing accuracy Chapter 27 - Page 346
What are 2 reasons for rigid bracing for patients with vertebral osteomyelitis?
1. Pain relief 2. minimize a kyphotic deformity Chapter 43 - Page 569
Give four descriptions of neuromuscular scoliosis onset during adulthood?
1. Painful 2. Progressive deformity (long sweeping type) 3. Early flexible than rigid 4. + - Kyphosis, lordosis, sagittal and or coronal imbalance Chapter 45 - Page 592
What are four designs of randomized controlled trials?
1. Parallel design 2. Crossover design 3. Factorial design 4. Expertise-based design Chapter 15 - Page 169
Focal radiculopathy secondary to foraminal stenosis and scoliosis requires what two part algorithm?
1. Partial curve correction with posterior instrumentation plus wide foraminal decompression 2. Interbody fusion (anterior, posterior, transforaminal or direct lateral trans-psoas)-added if #1 not successful to open foramen Chapter 45 - Page 589
What are five criteria recommended by the National Emergency X-Radiology Utilization Study (Nexus) for clinical cervical spine clearance (not needing imaging for C-spine clearance)?
1. Patient is cognitively unimpaired 2. Does not have neck pain 3. Non-focal neurologic exam 4. No tenderness, swelling, ecchymosis, or lacerations in the head and neck area 5. Pain free neck ROM Patients who meet all 5 of these criteria do NOT require cervical spine imaging studies. Chapter 48 - Page 624
Periacetabular osteotomy is contraindicated in which patients. Name four characteristics.
1. Patient with complete hip dislocation or high degree of femoral head subluxation 2. Patient with arthritic changes 3. Limited hip range of motion 4. Patient with an open triradiate cartilage Chapter 32 - Page 418
What are two indications for the use of an Inferior Venal Caval Filter (IVC)?
1. Patients at risk for PE (ie, prior history of DVT/PE, major trauma) who cannot be prophylaxed 2. Patients who have failed prophylaxis IVCs function by decreasing the incidence of pulmonary emboli but do not affect the incidence of DVT's. Chapter 12 - Page 138
Halo vests are unsuitable for which patients? Name five conditions.
1. Patients with chest trauma. 2. Obesity 3. Polytrauma patients particularly those with a skull fracture. 4. Patients with compromised respiratory function 5. Elderly frail patients Chapter 48 - Page 629
What are three indications for surgery in Juvenile Osteochondritis Dissecans of the knee?
1. Patients with unstable lesions. 2. Patients with persistent symptoms despite nonsurgical management. 3. And those with persistent lesions approaching skeletal maturity. Chapter 61 - Page 791
What are the two indications for surgical intervention in adolescent pelvic fractures?
1. Pelvic ring disruption > 2cm 2. Acetabular triradiate disruption > 2mm Triradiate fracture Chapter 57 - Page 727
Give two reasons why pelvic incidence is important with global (cervical, thoracic and lumbar curves-change in 1 curve influences other areas) sagittal balance?
1. Pelvis is the foundation of the spine 2. Pelvic morphology influences magnitude of curves in other areas Chapter 45 - Page 589
Describe the lateral pivot shift test?
1. Performed with the arm flexed over the head in a supine patient 2. The forearm is supinated 3. Elbow extended 4. Valgus load is placed across the elbow In this position the elbow is subluxation (radial head posterior to capitellum and widened ulnohumeral joint on fluoroscopic X-ray) 5. Elbow is slowly flexed, maintaining a supinated forearm and valgus load The radial head will reduce with an audible clunk (congruency on fluoroscopic X-ray) Chapter 27 - Page 345
What are four general characteristics of the Seronegative Spondyloarthropathies?
1. Peripheral arthritis 2. Enthesitis (inflammation at heelcord, tibial tuberosity, iliac crest, and other tendon insertion sites) 3. Axial inflammation (sacroiliitis and spondylitis) 4. Ossification of soft tissues leading to ankylosis Chapter 18 - Page 218
What are three characteristics of cellular senescence in cartilage?
1. Permanent arrest of cell division 2. Abnormalities in matrix metabolism 3. Alterations in gene expression Chapter 3 - Page 25
What are two typical neurodiagnostic tests results of multifocal motor neuropathy?
1. Persistent conduction block of motor nerves (2 or more) 2. Sensory nerve normal neurodiagnostics Chapter 19 - Page 233
What are three consequences of a missed injury leading to posteromedial rotatory instability?
1. Persistent incrongruity of the elbow 2. Altered kinematics 3. Early ulnohumeral joint arthrosis (Study of 18 pts post surgical repair followed up to 26 months. 6 had residual varus subluxation all of which developed arthrosis) Chapter 27 - Page 346
Gymnasts develop wrist pain due to repetitive tension and compression. This can lead to increased or decrease growth of the physis. Give four X-ray findings with overuse of the wrist.
1. Physeal widening 2. Changes in metaphyseal bone density 3. Distortion of the epiphysis 4. Premature physeal closure of the distal radius Physeal widening in a gymnast Chapter 61 - Page 790
What are five possible X-ray findings of thrower's elbow at the medial elbow?
1. Physeal widening of the medial apophysis 2. Fragmentation of the ossification center 3. Delayed ossification of medial epicondyle 4. Premature physeal closure of medial epicondyle 5. Avulsion fracture Adolescent pitcher with partial avulsion medial epicondyle Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 789 Chapter 61 - Page 789
What are six nonsurgical treatment options for OA?
1. Physical therapy 2. NSAIDS 3. Acetaminophen 4. Isometric exercise 5. Glucosamine & Chondroitin 6. Intra-articular steroids or hyaluronic acid Chapter 18 - Page 216
Infections of the lumbar spine can spread to which three areas via the anterior longitudinal ligament?
1. Piriformis fossa 2. Perianal region 3. Psoas muscle Chapter 43 - Page 565
What is the two-part treatment for dimelia?
1. Pollicization of the best radial digit 2. Ablation of the extra digits to create the thumb and four fingers Chapter 55 - Page 708
What two postoperative complications are readily detectable by CT scan imaging of total knee replacements?
1. Polyethylene liner dislocations 2. Component malrotation of patellar, tibial and femoral components Axial CT: Transverse epicondylar axis and posterior condylar axis should be parallel Chapter 8 - Page 92
Diabetic mellitus is associated with five different groups of neuropathy. 66% of type I diabetics develop neuropathy. What are the three risk factors for developing peripheral neuropathy in diabetics?
1. Poor diabetic control 2. Nephropathy 3. Retinopathy Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 231 Chapter 19 - Page 231
What are two characteristics of fixed sagittal imbalance syndrome?
1. Positive sagittal balance 2. Inability to stand upright Chapter 45 - Page 589
Inferior instability is characterized by what two provocative tests?
1. Positive sulcus test 2. Sulcus does not reduce with external rotation Sulcus sign maintained with external rotation Chapter 24 - Page 303
The posterior impingement sign can be positive with the classic dysplastic hip (anterior subluxation with apprehension), however what two possible pathologies can be implied in a hip with FAI?
1. Posterior acetabular pathology 2. Anterior and posterior acetabular damage(coup-contrecoup) Anterior and posterior acetabular damage(coup-contrecoup) Hip Disease in the Young, Active Patient: Evaluation and Nonarthroplasty Surgical Options Rafael J. Sierra, J Am Acad Orthop Surg December 2008 ;16:689-703. Chapter 32 - Page 414
What are three characteristics of Posterior Cord Syndrome?
1. Posterior aspect of cord affected 2. Motor function intact 3. Deep pressure, vibratory and proprioception absent Chapter 44 - Page 575
What are three tests for isolated PCL injury?
1. Posterior drawer at 90 degrees flexion 2. Posterior sag sign at 90 degrees flexion 3. Positive quadriceps active test Chapter 35 - Page 456
What are three posterior stabilizing structures?
1. Posterior glenoid rim 2. Posterior labrum 3. Posterior capsule Anterior capsular ligaments thicker than posterior counterparts Chapter 24 - Page 299
What are three characteristics of stage IIa posterior tibial tendon dysfunction?
1. Posterior tibial tendinopathy 2. Passively correctable deformity 3. < 30% uncoverage of the talar head on AP radiograph Chapter 40 - Page 527
What are three various recurrent elbow instability patterns?
1. Posterolateral rotatory instability 2. Varus posteromedial rotatory instability 3. Valgus instability Chapter 27 - Page 345
What are two relative indications for debridement and component retention with an infected total hip arthroplasty?
1. Postoperative infection within the first 4-6 weeks 2. Hematogenous infection (Presence of staphylococcus species worsens prognosis) Chapter 32 - Page 427
Congenital camptodactyly in young children may be difficult to differentiate from what two diagnoses?
1. Posttraumatic proximal interphalangeal contracture (fracture,tendon avulsion or tendon laceration) 2. Boutonnière deformity Chapter 55 - Page 705
What are two potential spine consequences with the use of intrathecal baclofen?
1. Potential increase in progression of scoliosis using ITB (intrathecal blacofen) -conflicting information in literature 2. Increased risk of infection and reoperation when ITB patients require spine surgery Chapter 63 - Page 812
What are seven management challenges of patients with ankylosing spondylitis and cervical spine injuries?
1. Pre-injury spine deformities therefore challenges with immobilization and prone positioning for surgery 2. Impaired bone quality 3. Propensity for epidural hematoma 4. Occult esophageal and aortic injuries 5. Intraoperative X-rays are difficult to discern given bony landmarks distorted 6. Decision-making : leaving spinal column near original kyphotic deformity versus realignment 7. Poor survival greater than 80 years Chapter 48 - Page 635
What are 4 complications of placing a rigid intramedullary nail through the tip of the greater trochanter?
1. Premature greater trochanteric epiphysiodesis 2. Coxa valga 3. Hip subluxation 4. Osteonecrosis (1 incidence reported) Chapter 57 - Page 734
Most acetabular pediatric fractures do well except those with triradiate cartilage injuries. What 2 complications can result from triradiate injuries?
1. Premature growth arrest of the triradiate cartilage 2. Hip Dysplasia (Early recognition of physeal bar is important to intervene surgically in attempt to prevent secondary dysplasia) Chapter 57 - Page 727
When imaging a patient with orthopedic hardware, what three factors can make a CT scan image show less artifact?
1. Presence of titanium implants instead of cobalt-chromium alloy 2. Using multiplanar reformatted images 3. 3-dimensional volume rendering Chapter 8 - Page 92
What are four advantages of hip resurfacing over traditional total hip arthroplasty?
1. Preservation of proximal femoral bone stock 2. Better restoration of hip biomechanics including minimizing leg length discrepancy 3. Increased ability to engage in high demand activities 4. Lower risk of dislocation Hip resurfacing Chapter 32 - Page 423
Indications for surgery for FAI include what three issues?
1. Preserved articular cartilage (Tonnis 2 or less) 2. Correctable structural abnormality 3. Reasonable expectations (FAI surgery not usually indicated in the fourth or fifth decades) Chapter 32 - Page 416
List three sources of pain following amputation.
1. Primary phantom pain 2. Referred from proximal source (spine, radicular, hip) 3. Referred from neuroma Chapter 41 - Page 540
In the past it was recommended with thoracolumbar curves not to end the proximal fusion proximal to the thoracolumbar junction to avoid complications. A recent study disproved this conclusion and revealed no difference between T9, T11 and L1. What two recommendations were made by this study?
1. Proximal fusion to neutral vertebra 2. Avoid proximal fusion ending at apex of thoracic kyphosis Chapter 45 - Page 588
What two corrective procedures are indicated with moderate to severe bunions?
1. Proximal osteotomy 2. Arthrodesis of first tarsometatarsal joint Chapter 40- Page 526
What three procedures are indicated for deficient soft tissue structure that causes the patella not to be engaged in the trochlea in early flexion? Radiographically MPFL femoral attachment site for reconstruction has been defined.
1. Proximal realignment procedure mainly repair or reconstruction of MPFL. 2. Lateral retinacular lengthening 3. Vastus medialis advancement Chapter 35 - Page 461
Surgical procedures for recurrent patella instability are categorized in what two groups?
1. Proximal-distal realignment 2. Combined realignment Chapter 35 - Page 461
A recent study of pedicle subtraction osteotomies for adult scoliosis revealed what two complications?
1. Pseudarthrosis 29% ( but not at osteotomy site) 2. Neurologic complications in 11% (3% permanent deficits) Chapter 45 - Page 591
What are three details of treating a missed Monteggia fracture surgically?
1. Radial head must retain its concave structure 2. Osteotomy of the ulna to correct the angular and length deformity 3. May require annular ligament reconstruction Chapter 53 - Page 682
What happens to the articulations of the elbow joint during posterior lateral rotatory instability?
1. Radial head subluxates posterior to capitellum 2. Rotation of semilunar notch away from trochlea Chapter 27 - Page 345
What are three characteristics of Fanconi Anemia?
1. Radial longitudinal deformity with pancytopenia 2. Presents later at ages 3 to 12 3. Requires bone marrow transplant Chapter 55 - Page 699
Name two disorders with abnormal F-wave studies.
1. Radiculopathy 2. Guillain-Barré (demyelinating disease) Chapter 19 - Page 229
What are three static secondary stabilizers of the elbow?
1. Radiocapitellar articulation 2. Common flexor origin 3. Common extensor origin Chapter 27 - Page 344 Chapter 27 - Page 345
Give two examples of how selection bias can occur in a randomization study.
1. Randomization is not concealed from enrollment investigator 2. Patients being excluded systematically. Chapter 15 - Page 171
What are three advantages of Low Molecular Weight Heparin (LMWH)?
1. Rapid onset of activity 2. Short half-life of about 4.5 hours 3. Laboratory monitoring not required Chapter 12 - Page 139
Chondrocytes respond to what quantities of rate, frequency and magnitude to stimulate matrix synthesis without degradation?
1. Rate (less than 1000 MPa/sec Megapascals Force per unit area per sec) 2. Frequency (0.1 to 1 Hz) 3. Magnitude (1-5 MPa megapascals per unit area is physiologic) If magnitude and rate exceeds the above numbers or frequency becomes static (<0.01) then chondrolytic activity increases Chapter 3 - Page 24
Which technique is better - open or arthroscopic - for recurrent shoulder instability?
1. Recurrence rates were similar for open and arthroscopic in randomized controlled trials. 2. Outcome scores were similar or slightly better with modern suture anchors for arthroscopic repair (systematic review of literature) Chapter 24 - Page 302
What are two indications for surgical repair of recurrent posterior shoulder dislocations?
1. Recurrent posterior shoulder instability 2. Pain with loading of arm in forward flexed position (bench press or football pass blocking) Chapter 24 - Page 303
In avascular necrosis as a result of radiation, what two modifications of the acetabular component improves results with total hip replacement?
1. Reinforcement ring 2. Highly porous metal socket Reinforcement acetabular ring Chapter 32 - Page 421
What are two surgical treatment options for mild ankle arthritis?
1. Resection of spurs causing ankle impingement 2. Ligament realignment/stabilization with calcaneal osteotomy Chapter 40 - Page 523
NPWT can be used through which two mediums?
1. Reticulated foam 2. Gauze Chapter 5 - Page 52
Name three potential painful pathologic conditions associated with the Achilles tendon insertion.
1. Retrocalcaneal bursitis 2. Tendinitis 3. Tendinosis Chapter 40 - Page 528
What is the ideal starting point for flexible intramedullary nail placement and what percentage of the canal should be filled at the isthmus?
1. Retrograde nail placed 2-2.5 cm above physis 2. Goal is to have 80% canal filling at isthmus (calculated by measuring diameter X 0.4 = nail size) Flexible nail or midshaft femur fracture, length stable Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 732 Chapter 57 - Page 734
In children less than 18 months old, fracture of which 4 bones are more likely to be the result of non-accidental trauma compared to older children?
1. Rib 2. Tibia-fibula 3. Humerus 4. Femur Chapter 57 - Page 731
Vertebral column resections provide more correction than pedicle subtraction method. More typically done in the thoracic spine not lumbar. Give five indications.
1. Rigid angular kyphosis and thoracic spine 2. Severe rigid scoliosis 3. Hemivertebra resection 4. Kyphotic deformity with tumor 5. Fracture or infection thoracic spine Chapter 45 - Page 592
Delayed union or non union can occur in pediatric femoral neck fractures. These complications can be reduced by what three principles?
1. Rigid internal fixation (even if it requires violation of physis) 2. Supplemental spica casting 3. Avoidance of weight bearing Chapter 57 - Page 729
What are two appropriate treatments for femur shaft fractures in patients greater than 11 years and over 100 pounds or length unstable fracture?
1. Rigid intramedullary (trochanteric entry) 2. Submuscular bridge plating Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 731 Chapter 57 - Page 731
What are two concerns of hip resurfacing?
1. Risk of fracture of femoral neck 2. Systemic and local effects of metal on metal wear particles Chapter 32 - Page 423
What are three dynamic stabilizers of the shoulder joint?
1. Rotator cuff 2. Long head of the biceps 3. Scapulothoracic rhythm Chapter 24 - Page 299
What two conditions commonly occur with shoulder dislocations in patients age 40 or older?
1. Rotator cuff tears 2. Neurologic injury (axillary nerve-loss of abduction and external rotation) Chapter 24 - Page 301
Which four bacteria are primarily responsible for vertebral osteomyelitis in developed countries?
1. S. aureus (50%) 2. E. coli 3. Enteroccocus 4. Proteus Chapter 43 - Page 565
The pelvic incidence is constant for each individual depending on their pelvic morphology. Pelvic incidence correlates strongly with what three measurements?
1. Sacral slope 2. Lumbar lordosis (angle of takeoff of LS spine) 3. Pelvic tilt Illustration showing the angles and measurements for pelvic incidence (a), sacral slope (b), and pelvic tilt (c). SS = sacral slope, PI = pelvic incidence, PT = pelvic tilt, VRL = vertical reference line, HRL = horizontal reference line. Chapter 45 - Page 589
Most patients with FAI present with groin pain but a small percentage present with trochanteric or gluteal pain. The trochanteric pain is felt 2° to abnormal gait mechanics. The posterior gluteal pain is felt due to posterior impingement or posterior acetabular wear. What are eight other causes of pain about the hip?
1. Sacroiliitis 2. Degenerative disk disease 3. Osteoarthritis of the hip 4. Avascular necrosis of the hip 5. Labral pathology 6. Gluteal muscle tear/strain 7. Stress fracture 8. Trochanteric bursitis Chapter 32 - Page 414
The Patte classification evaluates rotator cuff tears in which two planes?
1. Sagittal 2. Frontal Patte classification of rotator cuff tears. A. Rotator cuff tear topography in the sagittal plane is divided into six segments: -Anterosuperior tears (segments 1, 2, and 3) -Superior tears (segments 2, and 3) - Posterosuperior tears (segments 4 and 5) -Total cuff tears (segment 6). B. The topography of tears in the frontal plane is divided into three stages. Stage 1: the proximal stump shows little retraction Stage 2: retracted to the level of the humeral head Stage 3: retracted to the level of the glenoid. Reproduced with permission from Patte D: Classification of rotator cuff lesions. Clin Orthop Relat Res 1990;254:81-86.) "Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 306 Chapter 24 - Page 306
What are four reasons that correcting the sagittal imbalance can lead to coronal imbalance in surgical curve correction in adult scoliosis?
1. Sagittal balance is corrected by restoring lumbar lordosis 2. Lumbar spine more flexible than thoracic spine 3. Lumbar lordosis correction can lead to overcorrection of coronal curve 4. Leading to coronal imbalance Chapter 45 - Page 588
What are six steps of nerve regeneration following nerve injury after the cleanup process is complete?
1. Schwann cells proliferate at distal segment (bands of Bugner) 2. Neurolemma (outermost layer of Schwann cell) remains as a hollow tube in distal segment 3.. Proximal segment send out sprouts 4. Growth factors produced by Schwann cells and neurolemma (distal segment) attract sprouts 5. If sprout reaches tube, enters it 6. Sprout advances in tube 1 mm per day B. Early axonal sprouts C. Axonal sprouts enters distal segment neurolemma.supported by bands of Bugner(Schwann Cells proliferation) D. Successful axonal regeneration and reestablishment of neuro transmission E. Failure of regeneration (axonal sprouts crossing injury site) resulting in neuroma Chapter 19 - Page 228
Name 4 complications of traumatic pediatric hip dislocation.
1. Sciatic nerve injury (60-70% in adults improve) 2. Osteonecrosis 3. Coxa Magna (No functional limitations) 4.Redislocation(rare) Chapter 57 - Page 729
What are three orthopedic conditions of spinal muscular atrophy?
1. Scoliosis 2. Hip dysplasia (treatment and upon uni-versus bilateral and walking potential) 3. Contractures Chapter 63 - Page 819
What are three common spine deformities seen with myelomeningocele?
1. Scoliosis in 50-90 percent 2. Kyphosis 3. Lordosis Chapter 63 - Page 817
Bias is defined as deviation from the truth that is not by chance. What are four types of bias?
1. Selection bias 2. Ascertainment bias 3. Observational bias 4. Measurement bias Chapter 15 - Page 171
Describe three neurons that make up the reflex arc.
1. Sensory neuron enters dorsal root (nucleus and cell body at dorsal root ganglion) synapses with interneuron at dorsal horn 2. Interneuron travels from dorsal horn to ventral horn then synapses sitting with lower motor neuron. 3. Lower motor neuron exits ventral root travels to neuromuscular plate (ie activation of flexors and deactivation of extensors) Chapter 19 - Page 228
Name three disorders with abnormal H-reflex studies
1. Sensory neuropathies 2. Motor disorders affecting the sciatic or tibial nerves 3. S1 root lesions Chapter 19 - Page 229
Hereditary motor sensory neuropathies are group of disorders with what two general characterizations?
1. Sensory neuropathies 2. Progressive wasting of distal musculature Chapter 63 - Page 819
What four situations will reduce the amplitude of the response?
1. Severe conductance block and or axonal injury 2. Desynchrony of conductance (segmental demyelination) 3. Neuromuscular junction disorder (i.e. myasthenia gravis) 4. Myopathic lesions (motor nerve only given muscle response) Chapter 19 - Page 229
What are the 6 primary current indication for external fixation of pediatric femoral shaft fractures?
1. Severe disruption of soft tissue envelope 2. Burn injury 3. Multiple trauma 4. Arterial injury requiring immediate revascularization 5. Unstable fracture pattern 6. Unsuccessful nonsurgical management Chapter 57 - Page 734
List three warning signs that necessitate early treatment of SCH fractures:
1. Severe elbow swelling and ecchymosis 2. Neurologic deficit 3. Diminished or absent radial pulse Chapter 53 - Page 679
Modern anterior and posterior instrumentation with their rigid fixation have replaced some combined anterior and posterior surgery. Name four exceptions to this rule.
1. Severe fracture- dislocation 2. Fracture malunion 3. Displaced fracture-dislocation with ankylosing disorder 4. Severe multilevel posttraumatic myelopathy combined with cervical stenosis Chapter 48 - Page 632
When are three indications for open contracture release to restore motion in patients with dysfunction?
1. Severe stiffness 2. Significant amount of heterotopic bone 3. Ankylosis. Chapter 27 - Page 344
What are the three "cardinal signs" of compartment syndrome?
1. Severe, out-of-proportion pain 2. Tense swelling of compartment 3. Pain with passive stretch of muscles within compartment Chapter 37 - Page 479
When performing total hip arthroplasty for developmental dysplasia of the hip, what are two typical patterns of the native acetabulum?
1. Shallow acetabulum Open anterior laterally (excessive anteversion) 2. Completely deficient anteriorly and superiorly (Resulting in lateralized hip center) Chapter 32 - Page 418
What are two advantages of STIR sequences over fat-suppressed T2 images?
1. Short tau inversion recover (STIR) imaging results in markedly decreased signal intensity from over a large field of view 2. Metal artifacts are less pronounced STIR image on the right with osteochondritis dissecans lesion Chapter 8 - Page 95
What are three features of symbrachydactyly?
1. Shortened digits 2. Webed digits 3. Global hand or foot hypoplasia Chapter 55 - Page 702
What are four physical findings associated with complete absence of the radius?
1. Shortened forearm 2. Radial deviation of the wrist 3. Bowed thickened and shortened Ulna 4. Absent or hypoplasia of the thumb Chapter 55 - Page 698
What are two most common complications following treatment of a pediatric subtrochanteric femur fracture?
1. Shortening 2. Varus Chapter 57 - Page 729
What are four organ systems involved with Lyme's disease?
1. Skin- Erythma migrans 2. Neurolgoic-meningitis, Bell's palsy,paralysis, numbness, poor coordination of limbs 3. Cardiac- irregular, slow heartbeat 4. Musculoskeletal-arthritis WebMD Medical Reference
What are two radiologic methods to measure severity of slipped capital femoral epiphysis?
1. Slip Angle Mild: <30° Moderate: 30-60° Severe >60° 2. Slip Percentage (translation on AP and lateral views) Mild: <25% Moderate 25-50% Severe >50% Classification of slipped capital femoral epiphysis Chapter 58 - Page 746
What are three problems that can lead to Cam Impingement?
1. Slipped capital femoral epiphysis 2. Femoral retroversion 3. Posttraumatic deformities Chapter 32 - Page 414
When comparing functional bracing to closed intramedullary nailing prospectively for the treatment of closed tibial fractures, what five outcomes appears to be expected with functional bracing?
1. Slower return to work 2. Slower functional recovery of knee, ankle and hindfoot motion 3. Higher incidence of hindfoot stiffness 4. Slower healing rate 5. Higher incidence of malunion and shortening Chapter 37 - Page 481
What are six pathophysiologic changes that relate to compressive neuropathies?
1. Slowing of the nerve conductance 2. Ischemia 3. Edema 4. Phenotypic changes of Schwann Cells 5. Demyelination 6. Axonal dysfunction Chapter 19 - Page 228
Charcot-Marie-Tooth is a group of disorders which includes all forms of inheritance patterns. What are three characteristics of Charcot-Marie-Tooth?
1. Slowly progressive sensory loss 2. Muscle atrophy with weakness 3. Diminished deep tendon reflexes Chapter 63 - Page 819
What are three types and resection osteotomies?
1. Smith-Petersen 2. Pedicle subtraction 3. Vertebral column Chapter 45 - Page 588
Long used in the treatment of ALS, Riluzole (a Na channel blocker) affects SCI patients in what way?
1. Sodium channels are believed to be responsible for a large amount of white matter damage after SCI resulting in loss of calcium homeostasis. 2. Animal studies show Riluzole to reduce secondary damage around the injury with improved functional outcomes. 3. Human studies (SCI) soon to be initiated. Chapter 44 - Page 578
What are four MRI techniques to evaluate cartilage proteoglycan content?
1. Sodium imaging 2. T2 mapping 3. Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) 4. T1 rho imaging Fig. 7. Images of the medial and lateral mensici pre-surgery (A) and at two follow-up time points (B, C). The use of delayed gadolinium enhanced MRI of cartilage (dGEMRIC) imaging permits quantitative assessment of cartilage integrity which appears to improve following surgical intervention. Images courtesy of Deborah Burstein, PhD. Chapter 3 - Page 27
How should non displaced incomplete pediatric femoral neck fractures be treated?
1. Spica cast 2. Close follow up 3. Protected weight bearing Chapter 57 - Page 729
What are three treatment options for pediatric subtrochanteric femur fractures?
1. Spica casting 2. Traction and then spica cast 3. Surgical plate and screw vs. intramedullary Chapter 57 - Page 729
What three advantages are expected from bone bridge (osteomyplasty) procedure in transtibial amputation?
1. Stabilizes the fibula (less pain) 2. Increases bony surface for end weight-bearing 3. Closes intramedullary canal (?) Chapter 41 - Page 539
Which two radiographs are necessary to evaluate adult spinal deformity?
1. Standing 36-inch PA and lateral in and 2. Lateral radiographs with knees fully extended (evaluating sagittal balance) Chapter 45 - Page 586
What are three major goals of spine surgery with meningomyelocele?
1. Stop curve progression 2. Improved sitting balance 3. Prevent pressure sore formation including at the apex of a kyphosis deformity Chapter 63 - Page 817
Name three bands of the the medial collateral ligament and posterior medial corner complex.
1. Superficial medial collateral ligament (proximally origination is proximal posterior to the epicondyle and distally 6 cm below the joint line) 2. Deep layer of medial collateral ligament (meniscal femoral and meniscal tibial ligament) 3. Posterior oblique ligament (runs posterior to superficial MCL with multiple bands attached to posterior medial capsule, semimembranosus and proximal tibia) Chapter 35 - Page 454
What four muscles make up the rotator cuff? Give each muscle's innervations.
1. Supraspinatus (Suprascapular nerve) 2. Infraspinatus (Suprascapular nerve) 3. Teres minor (axillary) 4. Subscapularis (subscapular nerve) Rotator cuff muscles minus subscapularis with innervation Chapter 24 - Page 299
Name three major complications from spine surgery in meningomyelocele.
1. Surgical blood loss 2. Poor wound healing 3. Loss of curve correction Chapter 63 - Page 817
What are the three major types of Central Deficiencies?
1. Symbrachydactyly involves only one hand 2. Cleft hand (failure of formation and central hand) involves hands and feet, hereditary 3. Phocomelia Chapter 55 - Page 702
What are three hallmarks of RA?
1. Symmetric involvement of multiple joints in the feet and hands 2. Positive Rheumatoid Factor (IgM directed against the Fc portion of IgG) 3. Constitutional symptoms like weight loss, fever or malaise Chapter 18 - Page 217
Guillain-Barré is also an autoimmune disease brought on by response to bacterial or viral antigen. How does Guillain-Barré typically present itself?
1. Symmetrical weakness of the lower limbs first and rapidly ascends with or without dysesthesias. The weakness ascends usually over hours or days 2. Can progress to cranial nerves affecting protective swallowing and airway issues as well as respiratory difficulties Davids, H. "Guillain-Barre Syndrome". Medscape Reference. Retrieved 3 Jan 2012. Chapter 19 - Page 232
What are the common neurotransmitters for sympathetic and parasympathetic nerves? Name two.
1. Sympathetic: Norepinephrine 2. Parasympathetic: Acetylcholine Biology, Sylvia Mader - Page 715 Chapter 19 - Page 228
What are two sources of nutrition for articular cartilage?
1. Synovial fluid (at its surface), and through subchondral bone (at its base) since cartilage is avascular 2. Subchondral bone Chapter 3 - Page 23
What two organisms are associated with episodic septic arthritis?
1. Syphilis 2. Lyme's disease Chapter 18 - Pages 220-221
What are three other physical examination tests that demonstrate posterolateral rotatory instability?
1. Tabletop relocation test 2. Chair push up test 3. Floor push up test These tests are reliable in awake patients unlike the Lateral Pivot Shift test Chapter 27 - Page 345
What are three biomarkers associated with OA progression?
1. The crosslinked C-telopeptide of type II collagen (CTX-II) is a urinary marker of cartilage degeneration 2. Collagen type II and aggrecan (proteoglycan) products of proteolytic degradation 3. Collagen propeptide (PIINP) and chondroitin sulfate epitopes of aggrecan are markers of matrix synthesis Chapter 3 - Page 28
What are four major types of studies used by orthopaedic journals?
1. Therapeutic studies (investigate the results of treatment) 2. Prognostic studies (investigate a patient's characteristics on outcome of disease) 3. Diagnostic studies (investigate a diagnostic test) 4. Economic and decision analyses (developing an economic model or decision model) Chapter 14 - Page 158
The rate of proximal femoral shaft fractures is increased in the elderly population because of loss of bone density in the trabecular bone. How does the rate of femoral diaphyseal fractures compare with younger patients? What is the biomechanics behind this comparison?
1. There is no increase in diaphyseal shaft fracture rate in elderly patients 2. The structural resistance to bending (measured by second moment of inertia) is increased as the outer diameter increases as we get older. There is no compensation with trabecular bone therefore no increase rate of hip fractures. Illustration showing the influence of cross-sectional geometry on bending stiffness of basic structures. For example, increasing the outer diameter of a cylindrical structure from 10 mm to 12 mm while retaining a wall thickness of 2mm increases bending stiffness (I) by 82%. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 62 Chapter 6 - Page 62
What are three effects of immobilization on cartilage?
1. Thinning 2. Loss of mechanical properties with softening 3. Proteoglycan loss (Hypoxia may play a role in immobilizations effects) Chapter 3 - Page 24
What are three most common syndromes associated with Radial Longitudinal Deficiency?
1. Thrombocytopenia-absent Radius Syndrome 2. Fanconi Anemia 3. VACTERYL Chapter 55 - Page 698
What are three physical findings of Sever disease?
1. Tight Achilles tendon 2. Positive squeeze test 3. Pain over calcaneal apophysis Chapter 61 - Page 794
What two factors contribute to minimizing the risk of osteonecrosis following pediatric femoral neck fractures?
1. Timely reduction 2. Anatomic reduction Chapter 57 - Page 729
What newer type of intraoperative monitoring had earlier detection of impending spinal cord injury compared to somatosensory-evoked potentials during scoliosis surgery? How much sooner was the detection? Did somatosensory evoked potentials miss any motor deficits?
1. Transcranial electric motor evoked potentials 2. 5 minutes earlier on average 3. Somatosensory evoked potentials missed 4 of 7 patients with motor deficits Chapter 45 - Page 592
Name six non-medication based management modalities for residual limb pain.
1. Transcutaneous electrical nerve stimulation (TENS) 2. Desensitization 3. Acupuncture 4. Biofeedback 5. Mirror Therapy 6. Psychological support including relaxation (high levels of depression and anxiety up to 2 years after amputation) Chapter 41 - Page 541
Describe energy expenditures for transtibial, transfemoral, and bilateral amputations.
1. Transtibial - 25-40% above normal expenditure 2. Transfemoral - 68-100% above normal 3. Bilateral amputations over 200% above normal Chapter 41 - Page 537
What are three X-ray findings of pelvic discontinuity (separation of the superior and inferior halves of the hemipelvis)?
1. Transverse fracture line 2. Medial translation of the inferior hemipelvis 3. Asymmetry of the obturator foramen A.: Pelvic discontinuity as seen with Proposky Class IIIb requires ORIF of discontinuity Chapter 32 - Page 425
What are the four precipitating events for gout?
1. Trauma 2. Surgery 3. Excessive alcohol 4. Serious medical illness Chapter 18 - Page 220
What are four common causes for posterior shoulder dislocations?
1. Trauma to anterior aspect of shoulder 2. Indirect force applied to an adducted or flexed arm 3. Seizures 4. Electrocution Chapter 24 - Page 302
What are four classifications for tibial eminence fractures?
1. Type I minimal displacement of the tibial eminence 2. Type II displacement of the anterior third to one half of the tibial eminence 3. Type III the displaced tibial eminence is lifted from the bone 4. Type IV the fragment is rotated so the articular surface faces the bone Modified Myers in McKeever classification: a. = Type I; b.= Type II; c = type III; d.= Type IV (comminuted in M&M class. vs. rotated as per OKU 10) Chapter 61 - Page 785
What are two characteristics of Post Axial Polydactyl?
1. Ulnar side of hand 2. Autosomal dominant, African If occurs in whites, evaluate for other abnormalities Chapter 55 - Page 707
What are three static primary stabilizers of the elbow?
1. Ulnohumeral articulation (coronoid process) 2. Medial collateral ligament 3. Lateral collateral ligament complex Chapter 27 - Page 344
What are three parts of the pathology of Madelung's deformity?
1. Underdeveloped ulnar-palmar corner of the radius 2. The Vickers ligament tension on the the volar ulnar corner of the distal radius 3. Limited growth of the distal radius at the radial ulnar joint Intraoperative photo of Vickers ligament Chapter 55 - Page 710
What are 4 common benign bone tumors that can present as a pathologic fracture of the femur?
1. Unicameral bone cyst 2. Nonossifying fibroma 3. Eosinophilic granuloma 4. Aneurysmal bone cyst (Malignant conditions are far less common: Osteogenic sarcoma, Ewing sarcoma and lymphoma) Pathologic fracture of eosinophilic granuloma Chapter 57 - Page 731
What are three treatment options for sesamoiditis?
1. Unloading the sesamoids using splints or orthoses 2. Gastrocnemius-soleus complex stretching 3. Removal of the sesamoid Radiograph showing right foot lateral sesamoid disruption (arrow) with the left side as comparison. Chapter 40 - Page 528
What are three indications for contralateral pinning of asymptomatic hips in slipped capital femoral epiphysis?
1. Unstable SCFE 2. Younger than 10 years 3. Systemic metabolic disorders Chapter 58 - Page 747
What are two differences in upper and lower cervical spine injuries with regards to respiratory failure?
1. Upper cervical spine injuries lead to diaphragmatic function loss (rapid hypoxemic respiratory failure typically at the injury scene) 2. Lower cervical spine injuries cause slower failure due to intercostal muscle paralysis and poor chest wall expansion and slow hypercarbic ventilator failure. Chapter 44 - Page 573
Describe the motor pathway from cerebral cortex to skeletal muscle.
1. Upper motor neuron originate in the primary motor cortex (cell bodies) with long axons descending to medulla oblongata 80% cross over in medulla oblongata (brainstem, pathway forms 2 column like structures called pyramids)-lateral corticospinal tract 10% continue ipsilateral(cross over later just before exiting spinal cord)-anterior corticospinal tract 2. Synapses with interneuron (majority) or sometimes directly with lower motor neuron in ventral horn. Interneuron synapses with lower motor neuron in ventral horn. 3. Lower motor neuron with its nucleus in anterior horn exits ventral root as spinal nerve ending at neuromuscular plate Chapter 9 of "Principles of Physiology" (3rd edition) by Robert M. Berne and Mathew N. Levy. Published by Mosby, Inc. (2000) ISBN 0-323-00813-5.
What are the outcomes with nonsurgical treatment of multidirectional instability?
1. Variable results but up to 80% success rate 2. 1/3 of patients poor outcome at 8 year follow-up (1 study) Chapter 24 - Page 303
What is the mechanism of injury in varus posteromedial rotatory instability?
1. Varus force (compared to valgus force in posterior lateral rotational instability) 2. Proximal forearm pronates (compared to supinates in PLRI) relative to humerus resulting in Subluxation of the ulnohumeral joint into the defect created by the coronoid fracture Because radial head does not impact capitellum, radial head is usually spared Chapter 27 - Page 346
What are three typical foot malalignments in patients with Charcot-Marie-Tooth disease (and what causes them)?
1. Varus heel (weak peroneus brevis, PTT overpull) 2. Plantarflexed first ray (i.e., cavus - due to weak tib ant tendon) 3. Equinus contracture (due to weak tib ant, overpull of gastoc/soleus) Chapter 40 - Page 528
Distal femoral physeal injuries only makeup 2% of all physeal injuries and nondisplaced fractures can be easily missed. What three considerations should alert the physician of this possible injury?
1. Varus or valgus mechanism of injury 2. Associated injuries around the knee 3. Tenderness over physes with knee effusion Chapter 59 - Page 754
What are the five absolute indications to operatively treat tibial shaft fractures?
1. Vascular injury 2. Compartment syndrome 3. Irreducible or unstable fracture 4. Failure of closed treatment 5. Open fractures Chapter 37 - Page 480
What are two possible complication of proximal tibial physeal fractures in children?
1. Vascular injury and/or compartment syndrome 2. Partial or premature growth arrest, (leading to angular deformity and limb length inequality) Chapter 59 - Page 756
Besides core decompression, name two other non-arthroplasty procedures for avascular necrosis of the hip.
1. Vascularized fibular grafting (1 study showed long-term benefit even after subchondral colapse) 2. Decompression and injection of mesenchymal stem cells (best for early AVN) Vascularized fibular graft for avascular necrosis of the hip Chapter 32 - Page 421
What are two types of axis fractures other than odontoid?
1. Vertebral body fractures 2. Hangman's fractures (of axis) Chapter 48 - Page 625
The Pelvic tilt is measured between what two lines that meet at the center of the femoral head?
1. Vertical Line 2. Line extending from the middle of sacral endplate to center of femoral head Chapter 45 - Page 589
Name five metabolic/hormonal factors associated with Slipped Capital Femoral Epiphysis (SCFE) that should be considered?
1. Vitamin D 2. Thyroid hormone 3. Renal osteodystrophy 4. Pelvic radiation 5. Growth hormone (acronym: Good DTOX Growth hormone,vit D,Thyroid,renal Osteodystrophy, pelvic Radiation) Chapter 58 - Page 746
Name seven candidates indicating genetic link to degenerative disc disease.
1. Vitamin D receptor 2. Type IX collagen 3. Collagen type I 4. Interleukin-6 5. Aggrecan 6. Cyclo-oxygenase 7. MMP-3 Chapter 3 - Page 31
What are four features of performing hip arthroscopy after a hip dislocation?
1.Hip arthroscopy can be used to remove fragments from the joint 2.Typically done within several days of the injury 3. It may be easier to do after a dislocation since the capsule is torn and less force is needed for distraction 4. The torn capsule may allow fluid extravasation from the joint (reduce surgical time to prevent excessive fluid extravasation) Chapter 31 - Page 401
What are three procedures indicated for adult acquired flatfoot stage IIB?
1.Lateral column lengthening(risk of lateral column overload) Or 2.Medial calcaneal slide Or 3.Subtalar arthrodesis Lateral column lengthening with calcaneal osteotomy and graft Adult-acquired Flatfoot Deformity • Jonathan T. Deland J Am Acad Orthop Surg July 2008 ; 16:399-406.
Following closed reduction of a pediatric hip dislocation, why is it important to scrutinized the post reduction X-rays intraoperatively before reversing anesthesia? .
1.Non-concentric reduction from entrapped labrum, ligamentum teres, capsule or osteocartilaginous fragment (may not be picked up on postop CT given soft tissue entrapment) 2. Open reduction through approach in direction of dislocation (or Ganz technique) Posterior dislocation of a child's left hip. A, Radiograph showing the dislocation. B, AP pelvic radiograph showing the hip after attempted closed reduction. The hip is not concentrically reduced (arrow). C, CT showing the noncongruently reduced left hip (arrow). There are no entrapped osteocartilaginous fragments. D, MRI showing an enfolded ligamentum teres or capsule (arrow) causing the nonconcentric hip reduction. E, AP pelvic radiograph showing mild coxa magna and subtle femoral neck deformity 4 years after open reduction and removal of entrapped capsule and ligamentum. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 728 Chapter 57 - Page 728
Name six physical late physical findings of Duchenne Muscular Dystrophy
1.Progressive proximal muscle weakness 2. Increased Lumbar lordosis 3. Abdominal wall weakness with belly sticking out 4. Pseudohypertrophy of calf 5. Hamstring contracture, knees flexed during gait 6. Toe walking from achilles tendon contracture and foot drop weakness Duchenne Muscular Dystrophy, physical findings Chapter 63 - Page 818
The origin of the lateral collateral ligament is offset in what two directions from the lateral femoral epicondyle?
1.Proximal 2. Posterior (Brinkman JM, JBJS 2005;87Br:1364).
Humeral radial synostosis can be associated with hypoplasia of the ulna (Type 1) or a normal ulna (Type 2). What is the usual position of the elbow with each type and which is more functional?
1.Type 1 (hypoplasia of the ulna): Extension 2.Type 2 (normal ulna): Flexion Type 2 is more functional Chapter 55 - Page 705
"Number needed to treat "is defined as how many patients need to be treated (i.e. with medication A) to prevent one additional bad outcome. It is calculated by the formula 1/ARR (absolute risk reduction). What is the "number needed to treat" if the ARR equals 10%?
10 1 divided by 0.10 equals 10 Chapter 15 - Page 168
If 10 N is required to compress a cube 1 mm, what is the compressive stiffness?
10 N/mm squared divided by 1 mm equals 10 N/mm (The Math: 10 N/mm squared X 1mm/1 = 10 N/mm) Chapter 6 - Page 59
What is the maximum amount of weight for traction when used for a fluoroscopic guided test for ligamentous instability of the cervical spine?
10 pounds Chapter 48 - Page 624
What is the typical acceptable rate of a type II error?
10% Chapter 15 - Page 172
What is the reported re-rupture rate for Achilles tendon ruptures treated non-surgically?
10% Chapter 40 - Page 529
What percentage of patients with Legg-Calve-Perthes disease is bilateral?
10% Chapter 58 - Page 744
Up to what percentage of femoral head fracture-dislocations are not reducible by closed reduction?
10% 1. Treated emergently with ORIF 2. Emergent CT scan preop if no delay to OR Chapter 31 - Page 401
If the absolute risk reduction is defined as the "the absolute difference in the rate of harmful outcomes between experimental groups and control groups," what is the absolute risk difference if the infection rate in treatment A. is 10% and the infection rate in the control group is 20%?
10% 10% -20% = - 10 % (10% reduction) For every 100 patients with treatment A, an additional 10 patients will not get an infection or for every 10 patients 1 infection will be prevented. Chapter 15 - Page 168
What percentage of periacetabular osteotomies require intertrochanteric femoral osteotomy in the treatment of developmental dysplasia of the hip?
10% Femoral osteotomy is rarely indicated as a sole procedure Chapter 32 - Page 418
In patients with ankylosing spondylitis, what is the incidence of non-contiguous (non-adjacent) injuries?
10% Therefore the surgeon must maintain a high index of suspicion when evaluation a patient with a cervical spine injury with pre-existing ankylosing spondylitis. (The slightest crack may indicate an unstable injury) Neurodiagnostic studies of entire spine are indicated Chapter 48 - Page 635
What is the lateral overgrowth or lateral bump with lateral condyle fractures?
10% will have lateral condylar overgrowth Occurs in both casted and surgically treated Should be discussed with the family preoperatively
In certain autoimmune disorders, there is immune attack against peripheral nerve antigens such as certain proteins in myelin. In certain cases, an aberrant autoimmune response occurs as in the results of a normal immune response against bacterial infections (intestinal). Two types are chronic inflammatory demyelinating polyradiculopathy (CIDP) and multifocal motor neuropathy (MMN). CIDP is diagnosed in what percentage of initially undiagnosed peripheral neuropathies?
10-33% CIDP is distinguish from Guillain-Barré syndrome (most common acute acquired inflammatory demyelinating neuropathy) because it is progressive for at least 2 months Chapter 19 - Page 232
What is the incidence of AVN after a hip dislocation?
10-34% Chapter 31 - Page 401
What is the sensitivity and specificity of the moving valgus stress test for valgus instability?
100% sensitivity 75% specificity Chapter 27 - Page 346
How many colonies of bacteria per gram of tissue are needed to see harmful effects?
105 colonies per gram of tissue Chapter 5 - Page 52
The definition of scoliosis is a lateral deviation greater than how many degrees?
10° Chapter 45 - Page 585
Smith-Petersen osteotomies are typically performed at multi-levels and can be added to other corrective procedures. Depending on disc mobility, this osteotomy can gain up to how much lordosis per level?
10° Chapter 45 - Page 590
The 2009 Scandinavian ankle arthroplasty study compared surgeons' experience and the need for reoperation. What was the final reoperation rate after the component size was adaptive to smaller implants?
11% Chapter 40 - Page 524
What is the incidence of vertebral artery injury with significant cervical spine injuries?
11% Particularly with burst fractures, fracture-dislocations and fractures of the transverse foramen (C-6 to C-2). Due to blunt injury to the vertebral artery (pathology includes occlusion, dissection, aneurism and intimal tear) Chapter 48 - Page 636
What percent of studies in orthopaedic literature are Level 1?
11-16% Chapter 14 - Page 160
The incidence of ACL injuries in young athletes is increasing. In female athletes, the risk of ACL injury is increased over their male counterparts. The incidence of ACL injuries in females has a significant increase starting at what age?
12 to 13 years Chapter 61 - Page 786
What percentage of U.S. adults 60 and over have Osteoarthritis (OA) of the knee?
12% Chapter 18 - Page 213
What percentage decrease did Ostermann etal. show in infection rates when combining antibiotic bead pouches with systemic antibiotics as compared to systemic antibiotics alone when treating open fractures?
12% for systemic antibiotics only compared to 3.7% when systemic antibiotics were combined with antibiotic beads. (Statistically significant in Gustilo IIIB and IIIC for acute infection and in Gustilo II and IIIB for chronic osteomyelitis) Chapter 5 - Page 51
What pressure setting on the negative pressure wound management systems was shown to be the most efficient?
125 mmHg Chapter 5 - Page 52
What is the distance you must be away from the subchondral bone of the knee to be safe with external fixator pins?
14mm Chapter 37 - Page 481
With meningomyelocele scoliosis curve progression typically occurs before what age?
15 years Chapter 63 - Page 816
What percentage of posterior hip dislocations have femoral head fractures?
15% Chapter 31 - Page 401
What is the mortality of hematogenous vertebral osteomyelitis?
15% Chapter 43 - Page 565
How common is neurologic impairment involved in vertebral osteomyelitis cases? What two areas of the spine are most common?
17% More common with cervical and thoracic cases due to the narrower canal space Chapter 43 - Page 566
Suprascapular nerve compression can mimic the pain and weakness of a supraspinatus tear and/or infraspinatus tear. A suprascapular nerve compression can be associated with rotator cuff tears with retraction greater than how many centimeters?
2 cm Chapter 24 - Page 304
What is the indication for ORIF of intra-articular Salter Harris III or IV of the distal tibia epiphysis?
2 mm of intra-articular displacement either step-off or diastases Chapter 59 - Page 757
How long should a patient be off antibiotics before hip aspiration to prevent falsely negative results?
2 weeks Chapter 32 - Page 426
If external fixation is performed of a tibial shaft fracture, what is the time frame where it can safely be converted to an intramedullary nail?
2 weeks to reduce risk of infection Chapter 37 - Page 485
After how many weeks is a posterior shoulder dislocation defined as chronic and unlikely to be reduced closed?
2-3 weeks Chapter 24 - Page 303
Synovial fluid WBC count in OA is usually less than_______
2000 cells/microliter Chapter 18 - Page 214
What percentage of bone loss in the anterior glenoid can result in anterior shoulder instability?
21% (historically 25%) Arthroscopy: The Journal of Arthroscopic & Related Surgery Volume 28, Issue 7, July 2012, Pages 1030-1035 Area-Based Determination of Bone Loss Using the Glenoid Arc Angle Guillaume D. Dumont, M.D Chapter 24 - Page 299
What percentage of patients treated for meningomyelocele kyphosis correction with fusion and cord transaction developed postoperative hydrocephalus requiring shunt revision?
22% Therefore better preoperative shunt assessment and perioperative monitoring recommended. Chapter 63 - Page 817
What percentage of distal tibial physeal fractures (Salter-Harris type II) show premature physeal growth plate closure?
25% Chapter 59 - Page 757
Unilateral facet fracture-dislocations are the result of a flexion rotation injury. The typical X-ray shows a modest kyphosis and translation as much as what percentage of the vertebral body width?
25% Unilateral fracture-dislocation of the facet Chapter 48 - Page 633
Unacceptable shortening of a pediatric femur fracture is more than how many centimeters?
3 cm Chapter 57 - Page 731
How many months should there be between surgical procedures in the separation of adjacent digits?
3 months Chapter 55 - Page 704
When does the femoral head ossific nucleus become apparent on US and x-ray?
3 months on US 4-6 months on X-ray Chapter 58 - Page 741
The OATs procedure is used for larger osteochondral lesions of the talar dome with or without medial malleolus osteotomy. How many screws were used to fix the medial malleolus for stable fixation?
3 screws (preferable to 2 screws to prevent proximal migration) Medial malleolus osteotomy and talar dome being prepared for single core transplant (donor usually from ipsilateral femur) Chapter 40 - Page 526
What is the amount of time after which closed reduction of dislocated elbow is not likely to achieve successful restoration of stability or function?
3 to 4 weeks Chapter 27 - Page 348
How long should pins stay in place after closed reduction and pinning of a SCH fx in children?
3 weeks Chapter 53 - Page 678
At what age is Duchenne muscular dystrophy usually diagnosed in boys?
3-5 years in boys Chapter 63 - Page 818
After complete severance of a peripheral nerve, how long can the distal segment maintain it's integrity?
3-7 days after injury Chapter 19 - Page 228
In meningomyelocele scoliosis surgery, what percentage of patients had hardware complications?
33% (Loss of correction related to hardware failure) Chapter 63 - Page 817
What is the rate of meniscus extrusion after allograft surgery?
33% (usually occurs in first year post-op) Chapter 35 - Page 460
What is complication rate of the use of halo vest?
35% of patients with halo vests, most commonly pin site infections. Chapter 48 - Page 629
During revision hip surgery, cylindrical fully porous coated stems have shown reliable outcomes when at least_____cm of press fit is obtained between the stem and the femoral diaphysis.
4 cm Cylindrical fully porous-coated stem Chapter 32 - Page 425
What are the 1987 Revised Criteria for the Classification of Rheumatoid Arthritis?
4 of the 7 following criteria are diagnostic: 1. One hour morning stiffness for at least 6 weeks 2. Three or more inflamed joints 3. Arthritis of the wrist, hand, MCP or PIP joints > 6 weeks 4. Symmetric arthritic involvement 5. Rheumatoid nodules 6. Serum Rheumatoid factor as measured by a technique that yields a positive result in < 5% of normal subjects 7. Hand XR findings of periarticular osteopenia and erosions typical of RA Chapter 18 - Page 218
At what age should a child with bilateral or unilateral hip dislocations NOT be treated?
4 or 5 years if bilateral 6 years if unilateral Chapter 58 - Page 743
What is the recommended return-to-play guideline after ACL reconstruction?
4 to 9 months Chapter 35 - Page 454
How long should pins stay in place after closed reduction and pinning of a SCH fx in adolescents?
4-6 weeks Photo shows two lateral pins and a medial pin for fixation of a supracondylar humerus fracture. Chapter 53 - Page 678
What is the standard treatment for compartment syndrome associated with a tibial shaft fracture?
4-compartment release (Anterior, lateral, deep posterior & superficial posterior) Chapter 37 - Page 480
Surgery is indicated for hip subluxation with migration of what percentage in CP patients?
40-50 % migration percentage Chapter 63 - Page 814
What is the indication for surgical fusion and correction in regard to degrees of curve?
40-50° Chapter 63 - Page 813
Paralytic curves greater than how many degrees progress approximate 5° per year with myelomeningocele?
40° Chapter 63 - Page 816
What percent of autologous blood donations are wasted after TKA or THA?
45% ( In one study 61% of patients donated prior to surgery, but 45% of the blood was not used.) Chapter 12 - Page 141
What is the typical acceptable rate of a type I error?
5% Chapter 15 - Page 172
Surgeons have shown better patient outcomes with joint replacement if they perform more than ________ arthroplasties per year.
50 Chapter 18 - Page 216
What is the rate of spinal involvement in patients with systemic tuberculosis?
50% Chapter 43 - Page 567
Distal femoral physeal fractures can develop shortening and angular deformity. The need for additional surgery is expected in what percentage of cases (despite anatomic reduction)?
50% (Avoid multiple attempts at closed reduction to prevent further injury to growth plate) Chapter 59 - Page 755
What percentage of patients with Legg-Calve-Perthes disease develop premature osteoarthritis?
50% (In patients with significant femoral head deformity most function well into the fourth and fifth decade of life) Chapter 58 - Page 745
What percentage of medial epicondyle fractures are associated with dislocated elbows?
50% (Post reduction radiographs are elbow dislocation always look for an entrapped medial condyle) Chapter 53 - Page 681
The relative risk reduction is equal to one minus the relative risk. If the relative risk is 0.5 or 50% what is the relative risk reduction?
50% 1 - RR = 50% Chapter 15 - Page 168
What is normal range for Baumann angle?
64 o to 81 o and averaging 72 o in children Figure shows a schematic drawing showing the Baumann angle, which is formed by a line parallel to the humeral shaft and a line parallel to the lateral condyle physis. (Baumann angle is important for reduction of supracondylar fractures in the coronal plane) Chapter 53 - Page 677, Figure 3
The Ponseti method (clubfoot casting technique) decreases the extent of corrective surgery in meningomyelocele clubfoot deformities. What is the recurrence rate of deformity as compared to the idiopathic group?
68% in meningomyelocele patients compared to 26% and idiopathic clubfeet (Feet there were an insensate had more complications with casting) 2-year-old with right foot L4 level calcaneal deformity and left foot L3 level club foot Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 817 Chapter 63 - Page 817
Patients with symptomatic FAI have a mean alpha angle of?
74 degrees Compared to 42 degrees in control groups Alpha angle is measured with two lines at center of head, 1st line extends from center of neck to center of head and 2nd line extends from center of head to junction of head neck at circle. Normal is 50 to 55 Chapter 32 - Page 415
What percentage of traumatic hip dislocations are associated with other systemic and muscle skeletal injuries?
75% ATLS (Advanced Trauma Life-Support) should be initiated in patients who have a hip dislocation. Chapter 31 - Page 399
What percentage of patients have os acromiale?
8% Chapter 24 - Page 304
What percentage of hips with FAI have a combined type of impingement?
80% Chapter 32 - Page 414
What is the expected outcome of arthroscopic osteophyte resection and capsulectomy in primary osteoarthritis?
81% reported good to excellent results with significant decrease in pain. Chapter 27 - Page 343
What is the shoulder dislocation recurrence rate with contact athletes when anterior bony deficiencies from 20% to 30% were treated with soft tissue procedures only?
89% recurrent instability Chapter 24 - Page 302
What percentage of patients with preop autologous blood required allogenic blood transfusions?
9% Chapter 12 - Page 141
What is the percentage of recurrent shoulder dislocation in the pediatric population?
90% Chapter 61 - Page 788
What percentage of children with cerebral palsy developed hip subluxation or dislocation in GMFCS level V?
90% in GMFCS group V Chapter 63 - Page 814
What are the results of reconstruction of valgus instability?
90% of patients return to pre-injury level of throwing and sports participation.(Biomechanical study: interference screw fixation of ulnar side yields graft fixation strength equal to 95% of native MCL under valgus loading.) Chapter 27 - Page 348
What percentage of occult fractures have a positive technetium bone scan within the first 24 hours?
90-95% of fractures within 24 hours of the trauma will have positive technetium bone scans, but may be negative in the initial 24 hours Chapter 8 - Pages 98
By convention, what is the accepted confidence interval?
95% If the trial is repeated 100 times, 95 of 100 times the result will fall within the 95% confidence interval. 5% of the time those results will fall outside of the confidence interval and erroneously would be concluded that there was a difference between the groups when actually there was not. Chapter 15 - Page 173
In asymptomatic hip dysplasia with VCA and CE angles of 10 and 15 degrees respectively and labral tear on MRI arthrogram, what pelvic osteotomy is indicated and what should be done with the labral tear?
A = Salter, B. = Dega. C. =Ganz periacetabular osteotomy Which osteotomy above should be done? Answer C. Ganz periacetabular octeotomy. Labral tear repaired open or arthroscopically Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 744 Chapter 58 - Page 744
What is adult de novo scoliosis, or degenerative scoliosis?
A condition that did not exist before skeletal maturity and developed in adulthood Chapter 45 - Page 587
What is a diagnostic study?
A diagnostic study evaluates the performance of tests designed to detect the presence or absence of a particular condition. The study under evaluation is usually compared to the 'gold standard,' making the study high quality. Chapter 14 - Pages 159 - 160
In distal tibial physeal fractures, what condition can mimic a compartment syndrome?
A displaced fracture fragment impinging on the Extensor Hallucis Longus and deep peroneal nerve (extensor retinacular syndrome) Chapter 59 - Page 757
Why should femoral neck stress fractures be treated with caution?
A displacement of the femoral neck stress fracture can lead to osteonecrosis Chapter 61- Page 792
What is a vector?
A force acting on an object (i.e. a joint) Depicted by a line of action of a force Correct answer = C Chapter 6 - Page 62
What is the definition of a pediatric subtrochanteric fracture?
A fracture that occurs within 10% of the femur's total length below the lesser trochanter. Chapter 57 - Page 729
What constitutes a Level 2 therapeutic study?
A lesser quality randomized controlled trial or prospective comparative study Chapter 14 - Page 159
What is a moment?
A magnitude of force, F, acting at a distance, d, from a joint Moment, M=F x d M linearly increases with the perpendicular distance (lever arm) of the force vector from the joint 500N x 2 m = 1000N x 1m therefore no rotation and balanced Moments Chapter 6 - Page 62
What is the Koshino Index?
A measurement of patella alta in a skeletally immature patient. KI =PT/FT Koshino index, KI =PT/FT Chapter 63 - Page 814
What is a case series?
A study evaluating patients treated in one way without any comparison group of patients treated in another way Chapter 14 - Page 159
What is the ideal length of transfemoral amputation?
Above Condylar flare at the level of the adductor tubercle Allows for socket, adapter connection to knee (Too short loses use of hip musculature) Ideal transfemoral amputation at adductor tubercle level Chapter 41 - Page 538
What are four indications for surgical repair with fixation of a displaced medial epicondyle fracture?
Absolute Indications 1. Open fracture 2. Recalcitrant incarcerated following elbow dislocation Relative Indications 3. Ulnar nerve symptoms and valgus instability 4. High demand athletes i.e. throwers, gymnasts and wrestlers (partial displaced and complete displacement)-controversial ORIF medial epicondyle fracture,NB unicortical and directed upward to avoid radial nerve and olecranon fossa Medial Epicondyle Fractures in the Pediatric Population, Hilton P. Gottschalk, J Am Acad Orthop Surg April 2012 ; 20:223-232.;doi:10.5435/JAAOS-20-04-223 Chapter 61 - Page 787
The crossover sign on an AP pelvic X-ray is indicative of what?
Acetabular retroversion In a retroverted acetabulum the anterior acetabular rim crosses over the posterior acetabular rim Xray on the right: AP radiograph of the hip of a 19-year-old man with isolated retroversion of the acetabulum The black line depicts the posterior wall, and the white line depicts the anterior wall. The crossover between the anterior and posterior walls occurs more caudal than normal. Xray on the left is a normal hip. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 414 Chapter 32 - Page 414
What is considered to be appropriate component positioning for THA?
Acetabulum: 15 degrees anteversion 40 degrees of abduction Femur: 10 to 30 degrees of anteversion. Chapter 32 - Page 425
What is the Stinchfield Maneuver?
Active straight leg raising test to 30 degrees with patient resisting downward force, reproduces groin pain from intraartcular pathology by increasing contact pressure (Sensitive but not very specific) Active straight leg raising test (Stinchfield) Chapter 32 - Page 414
What is the arm position with a posterior shoulder dislocation?
Adduction and forward flexion Chapter 24 - Page 299
What is the benefit of obtaining blood cultures in the setting of Vertebral Osteomyelitis?
All patients should receive blood cultures and about 85% can be expected to yield a positive result. It is important to avoid antibiotic therapy to increase the likelihood of positive cultures. Chapter 43 - Page 566
What pattern of skin closure was shown to result in the least effect on blood flow? Management
Allgower-Donati Chapter 5 - Page 53
The presence of symptomatic femoral acetabular impingement correlated with what X-ray finding following treatment for slipped capital femoral epiphysis?
Alpha angle (head-neck junction morphology) (Did not correlate with severity of slip) Alpha angle A line drawn from the center of the femoral head to the center of the femoral neck. A second line drawn from the center of the femoral head to the femoral head neck junction, the point by which the femoral neck divergence from the circle. Normal = 50-55° Chapter 58 - Page 746
Ultrasound of the DDH hip examines two angles, alpha and beta. Describe how to measure them.
Alpha: angle between a line along the lateral wall of the ilium (l in coronal projection below) and a line tangential to the bony roof of the acetabulum (BA). Normal Alpha >60° Beta: angle between a line along the lateral wall of the ilium and a line tangential to the cartilaginous labrum (+---------+). Normal Beta <55° Schematic and ultrasound demonstrating alpha and beta angles on coronal view Chapter 58 - Page 740
What is a comparative study (cohort study)?
Also known as a cohort study. It involves the comparison of one group of patients treated in a particular way with another group of patients treated in another way. Chapter 14 - Page 159
What is considered a prospective study?
An investigation in which the study was initiated (research question posed) before the first patient was enrolled or treated Chapter 14 - Page 159
How is the diagnosis of Osteogenesis imperfecta made?
Analysis of collagen produced from cultured dermal fibroblasts Chapter 57 - Page 731
What is the best acetabular reconstruction choice for a Crowe IV (complete dislocation)?
Anatomic hip center (True acetabulum usually has thicker bone) 1. Graft usually not needed 2. Requires trochanteric slide or Subtrochanteric shortening osteotomy (to prevent over-lengthening) Crowe IV with subtrochanteric shortening osteotomy, allograft used in this particular case for acetabulum (graft usually not needed in Crowe IV Chapter 32 - Page 418
What is the Tonnis angle?
Angle of weightbearing surface or sourcil Tonis angle, approximately 10° Chapter 32 - Page 418
Although no valid human studies exist, what is the thought process behind systemic hypothermia in SCI patients?
Animal models have shown systemic hypothermia (30-32 C) to have a wide range of histologic and biochemical effects, such as 1. Blunted neutrophil invasion 2. Reduced oxidative stress 3. Reduced secondary damage. Chapter 44 - Page 578
Which compartment is most frequently incompletely released?
Anterior Chapter 37 - Page 480
What vascular complication is associated with tibial tubercle fractures?
Anterior compartment syndrome secondary to bleeding from recurrent anterior tibial artery Chapter 59 - Page 756
Amyotrophic lateral sclerosis (Lou Gehrig's disease) is painless very progressive weakness that involves certain motor cranial nerve nuclei, the corticospinal, corticobulbar tract(controls tongue, pharynx and larynx) and what part of the lower motor neurons?
Anterior horn cells of the spinal cord UMN and LMN disorder Chapter 19 - Page 235
What shoulder ligament is stretched with the arm in the abducted and external rotated position?
Anterior inferior glenohumeral ligament Chapter 24 - Page 299
What is the most common complaint after intramedullary nailing of the (Study to Prospectively Evaluate Reamed Intramedular Nails in Patients with Tibial Fractures) tibia?
Anterior knee pain (67%) Occurs in up to 67% of patients who undergo anterograde IM nailing. Although the exact etiology is unclear, iatrogenic injury during creation of the starting point and during nail insertion, nail prominence, quadriceps weakness, and use of a transpatellar tendon surgical approach have been implicated. Chapter 37 - Page 482
What procedure is indicated for increased Q angle documented by trochlear groove to tibial tubercle distance of more than 20 mm on axial CT scan?
Anterior medialization tibial tubercle osteotomy TT-TG measurement Chapter 35 - Page 461
What may impede reduction of a displaced tibial eminence fracture?
Anterior meniscus tissue or intermeniscal ligament Entrapped anterior horn medial meniscus after displaced tibial spine fracture Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 785 Chapter 61 - Page 785
Patients with dysplastic hips will have a positive apprehension sign
Anterior subluxation of the femoral head with extension and external rotation in developmental dysplasia (same maneuver as posterior impingement sign) Apprehension test in developmental dysplasia Chapter 32 - Page 417
Which muscles make up the transverse force couple of the shoulder (1-anteriorly, 2-muscles posteriorly)?
Anteriorly 1. Subscapularis Posteriorly 1. Infraspinatus 2. Teres minor Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 301 Chapter 24 - Page 301
The myelin membranes generated molecules inhibit axonal regeneration within the CNS. What antibiody was developed to promote axonal regeneration through blocking the myelin inhibitors?
Anti-Nogo antibody Chapter 44 - Page 576
Screw displacement axes (SDA) or helical axes represent what?
Any arbitrary motion of bone segment can be accomplished by rotation around and translation along a unique axis (calculated from 6° of freedom motion data) Illustration showing a characterization of joints. A, A series of SDAs obtained from incremental joint motion represents the location and dispersion of rotation axes over the elbow range of motion. The smaller the axes dispersion, the closer the joint resembles an ideal hinge joint. The angles between the average SDA and the ulnar and humeral shaft axes are denoted by ß1 and ß2, respectively. B, Graph showing joint laxity of the elbow, represented by the permissible varus-valgus rotation from a neutral motion path in response to defined varus-valgus loads over the flexion range of motion. (Reproduced with permission from Bottlang M, Madey SM, Steyers CM, Marsh JL, Brown TD: Assessment of elbow joint kinematics in passive motion by electromagnetic motion tracking. J Orthop Res 2000;18:197-198.) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 65 Chapter 6 - Page 65
What is the Galeazzi sign?
Apparent femoral length discrepancy, when the legs are held together with the hips and knees flexed Galeazzi sign Chapter 58 - Page 740
Cells make up what volume of the disk?
Approximately 1% Chapter 3 - Page 29
At what levels are most cervical spine fractures located in patients 65 years and older?
Approximately 2/3rds of fractures involve C0-C2 level (They can be caused by low-energy mechanisms, such as a fall from standing) Figure displays a CT scan of a type II odontoid fracture in a 71 year old man. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 85 Chapter 8 - Page 85
What is the reported incidence of traumatic disk herniation associated with unilateral cervical spine facet fracture dislocation?
Approximately 23% Approximately 13% for bilateral facet dislocations Unilateral facet dislocation with HNP Chapter 48 - Pages 633-634
What is the 1-year mortality rate in geriatric patients with type II odontoid fractures?
Approximately 40% Chapter 48 - Page 631
Increased uptake on technetium radionuclide bone scan represents what?
Areas of increased bone remodeling show increased uptake, such as tumors, infection, trauma or metabolic bone disease Chapter 8 - Pages 98
What significant complication exists with the surgical repair of displaced tibial eminence fractures that necessitates secure fixation for early range of motion?
Arthrofibrosis Chapter 61 - Page 785
What is the best treatment for lytic lesions of the femoral neck or femoral neck pathologic fractures?
Arthroplasty Chapter 31 - Page 406
How soon should antibiotics be administered for open fractures?
As soon as possible After three hours the risk of infection increases Chapter 5 - Page 50
When should the soft tissue reconstruction be done?
As soon as possible, but it can safely be done when the patient's other injuries have been stabilized. Up to 3 days is no longer the gold standard. 3 days to 90 days can be appropriate. Chapter 5 - Page 53
When the participants have knowledge of which intervention each participant received, what type of bias could this be?
Ascertainment bias 1. In surgical cases, impossible to blind the surgeon but maybe possible to blind patient. 2. Results in greater treatment fracture when not blinded Chapter 15 - Page 171
How is a gouty tophus differentiated from a rheumatoid nodule?
Aspiration yields monosodium urate crystals in tophi and rheumatoid nodules yield cholesterol crystals Photo of Gouty Tophi Chapter 18 - Page 217
What is VACTERL?
Association of Vertebral abnormalities Anal atresia Cardiac malformations Trachea-Esophageal abnormalities Renal anomalies Limb anomalies (radial deficiency/ polydactyly/syndactyly) Chapter 55 - Page 699
What does the negative charge of the aggrecan molecule attract and why is that important?
Attracts water molecules that provide hydrostatic pressurization of the matrix, enabling cartilage to resist deformation. Chapter 3 - Page 23
What is the genetics of syndactyly?
Autosomal dominant with variable penetrance Chapter 55 - Page 704
What is the most worrisome complication associated with ORIF of lateral condyle fractures more than 3 weeks post injury?
Avascular necrosis Chapter 53 - Page 681
What is the Bankart lesion?
Avulsion of the labrum of the anteroinferior glenoid Chapter 24 - Page 300
Medial clavicular injuries are typically growth plate injuries in teenagers and difficult to diagnose on routine X-rays. What is the recommended diagnostic study for a patient with pain and swelling near the sternoclavicular joint?
Axial CT scan Figure shows CT showing a posteriorly displaced fracture of the sternoclavicular joint (arrow). Chapter 53 - Page 675
What group of organism is associated with acute mono or oligoarticular septic arthritis?
Bacterial Chapter 18 - Pages 220-221
How to differentiate benign fasciculations from motor neuron disorder? Give three examples of each.
Benign fasciculations 1. No muscle weakness 2. Normal EMG 3. Restricted in distribution Motor neuron disorder (ALS) 1. Muscle weakness (cramping elicited during motor testing) 2. Abnormal EMG 3. Multifocal and continuous Chapter 19 - Page 236
What is the typical value for beta and Power?
Beta 0.2 Power 0.8 (1 - beta) Chapter 15 - Page 173
How is study power related to type II errors?
Beta equals power Beta = the probability of committing a type II error Power = the probability of finding a difference when there is a difference Chapter 15 - Page 173
Congenital limb bud deformities occur between how many weeks after fertilization?
Between 4 weeks (limb bud begins to develop) and 8 weeks (upper limb is fully formed) gestation At 4 weeks embryo is the size of a grain of rice and at 8 weeks it is the size of a silver dollar Chapter 55 - Page 697
The medial clavicle physis closes when?
Between ages 20 - 25 Chapter 53 - Page 675
How do bilateral and unilateral coxa vara patients differ in their clinical presentation?
Bilateral: Decreased lumbar lordosis Unilateral: Trendelenburg gait Limb length discrepancy Chapter 58 - Page 744
How does "block randomization" improve randomized control trials with stratification?
Blocking ensures that patients are evenly distributed within different stratification groups. If block size = 4, and if first 3 are randomized to A, B, A then the 4th is automatically assigned to B. Then the blocks are randomized. Chapter 15 - Page 169
Bone biopsies and soft tissue tumors are guided by what radiologic means?
Bone biopsies: CT guided Soft tissue tumor biopsies: Ultrasound-guided Open magnet MRI guided biopsies very good for bone lesions, fair for soft tissue lesions Chapter 8 - Page 102
What is recommended for Hill-Sachs lesions greater than 37.5% of the joint surface?
Bone grafting Osteochondral grafting of adolescent with large Hill-Sachs lesion Chapter 24 - Page 302
What is the growth factor added to tricalcium phosphate/hydroxyapatite crystals was found to be equal to autologous bone graft in adult deformity surgery? The fusion rate was 100% at 2 years follow-up.
Bone morphogenic protein-2 Chapter 45 - Page 593
Enthesitis is chronic inflammation at the tendon/ligament insertions. It is seen in ankylosing spondylitis, seronegative arthropathies and reactive arthritis. Erosions initially occur at the capsular insertion followed by what?
Bony proliferation Bony erosion at capsular insertion and bony proliferation typically seen on iliac side (ankylosing spondylitis) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 87 Chapter 8 - Page 87
In spinal muscular atrophy, the genetics are autosomal recessive, from whom did the child gets the spinal muscular atrophy gene?
Both parents Chapter 63 - Page 819
In 2009, Owens etal. showed a reduction in bacterial rebound at 48 hours when treating contaminated wounds with which of the following: bulb syringe or pulsatile irrigation?
Bulb syringe Chapter 5 - Page 50
What mechanism leads to a cuboid "nutcracker" fracture?
Burst-type fracture when the foot is forcefully abducted and sustains an axial load If significant lateral column shortening, restore surgically Chapter 59 - Page 759
How has the advance to posterior only approach with pedicle and sacral screws benefited neuromuscular children who needs scoliosis surgery?
By eliminating the anterior approach there is no further compromise of the chest wall musculature and diaphragm (which may already be weakened by proximal weakness of a neuromuscular disorder) Chapter 63 - Page 811
What is the benefit of acromioplasty and subacromial decompression?
By smoothing out the arch undersurface cuff pressure is relieved (without disrupting deltoid origin or destabilizing coracoacromial arch) Chapter 24 - Page 306
What is the X-Ray finding of clinodactyly?
C-shaped physis that results in a triangular delta phalanx Chapter 55 - Page 705
What is the appropriate treatment for transverse atlantal ligament disruption? What three options are there?
C1-C2 arthrodesis 1. Cable or wire fixation with bone graft(secondary role mainly to hold graft) 2 Segmental fixation of C1-C2 with transarticular screws 3. Segmental fixation with C1 lateral mass screw and C2 with pedicle, pars or translaminar screws Segmental fixation was C1 lateral mass screw and C2 pedicle screw Chapter 48 - Page 630
What are the concerns of the cervical spine with general anesthesia in rheumatoid arthritis patients?
C1-C2 subluxation (requiring fiberoptic intubation) Chapter 18 - Page 217
Type III Hangman's fracture has a C2 on C3 facet subluxation in addition to the bilateral pars fracture. Why does this require surgical intervention?
C2 posterior pars and lamina are separated from the anterior C2 and above and separated from C3 and below i.e. "floating" (C1-C3 or C2-C3 arthrodesis with segmental instrumentation) Type III Hangman's fracture with "floating" posterior pars and lamina of C2 Chapter 48 - Page 631
What female genotype has a lower risk of ACL rupture?
CC genotype of the COL5A1 BstUI RFLP gene for the α1 chain of type V collagen Chapter 35 - Page 453
Define lateral Center-edge angle (the angle of Wiberg) and what are normal angles?
CE angle, Center-Edge Angle of Wiberg = vertical line drawn through the center of the head and a second from the center of the head to lateral edge of acetabular Normal CE angle >25° Chapter 58 - Page 744
Charcot-Marie-Tooth is the most common type of hereditary neuropathy and is a family of genetically distinct disorders with the pathology focused on the Schwann cell (some types have axonal involvement). Type I CMT is the most common. There is progressive cavus foot deformity with weakness of the tibialis anterior and perineal muscles (as well as the intrinsics). What clinical feature distinguishes CMT from acquired forms of neuropathy?
CMT patients typically do not have numbness or tingling as do acquired forms of neuropathy (there is reduced sensation on exam) "Inverted champagne bottle" muscle atrophy of CMT Chapter 19 - Pages 234-235
What is the most appropriate imaging modality in all trauma patients over 75 years in evaluating the cervical spine?
CT Chapter 8 - Page 85
What is the method of choice for evaluating after closed or open reduction for dysplasia of the hip dislocation?
CT scan (MRI in some centers) Chapter 58 - Page 741
What hindfoot and surgery can be done for equinovalgus deformity in CP patients?
Calcaneal neck lengthening (subtalar fusion or calcaneal sliding osteotomy for severe deformity) Lateral column lengthening (calcaneal neck lengthening) correcting valgus deformity Chapter 63 - Page 815
What is Severs disease?
Calcanel apophysitis. Apophysitis Sever disease Chapter 61 - Page 794
If there is significant lysis at the trochanteric area, what besides a cephalomedullary nail could be a treatment choice?
Calcar replacement arthroplasty Chapter 31 - Page 406
What is a pistol grip deformity of the proximal femur?
Cam deformity of the femoral head with the contour of the femoral head extends into a convex shape onto the neck Pistol grip deformity Chapter 32 - Page 414
In Type III Seddon peripheral nerve injuries (neurotmesis), what is the prognosis?
Can result in complete death of the nerve and requires surgical intervention Chapter 19 - Page 228
Both meniscus are attached to_____ at the periphery.
Capsule Chapter 35 - Page 458
What is Holt-Oram Syndrome?
Cardiac abnormalities associated with thumb hypoplasia or other upper extremity anomaly. Most common Heart -Limb Syndrome Chapter 55 - Page 699
What other medical specialty is important for medical clearance prior to surgery with Friedreich's ataxia?
Cardiology (cardiac hypertrophy) Chapter 63 - Page 820
What constitutes a Level 4 study?
Case series Chapter 14 - Page 159
A prospective or retrospective study of patients receiving particular treatment from a single surgeon or single institution is what?
Case series Chapter 15 - Page 171
Name the type of study that is, by definition, always retrospective and first identifies an outcome and then examines individual patients. Give two examples of when this type of study is helpful.
Case-control study 1. Useful for rare outcomes or disease 2. Helpful determining hypothesis, incidence rates, odds ratio etc. Chapter 15 - Page 171
How does the case-control study differ from a retrospective cohort study?
Case-study 1. Patient with certain outcome of interest is identified 2. Matched with a control patient without this outcome 3. Research back words to identify factors associated with this outcome of interest Retrospective cohort study 1. Already established database 2. 2 cohorts identified (exposed and not exposed) 3. Followed for outcome which originally is unknown Chapter 15 - Page 171
What Is the Treatment Indicated for a Type I (nondisplaced) supracondylar humerus? fracture?
Casting 3 weeks Chapter 53 - Page 677
What is the treatment indicated for a Type I lateral humeral condyle fracture?
Casting and close followup Chapter 53 - Page 680
What is the "organ pipe" arrangement following multiple osteochondral transplants in the talar dome?
Catching sensation because of unevenness of grafts Chapter 40 - Page 526
If the patient has no specific medication allergy, what antibiotic should be used for perioperative prophylaxis? (Assuming that there is no patient history of MRSA)?
Cefazolin Given 1 hour prior to surgery and repeated if the operation exceeds 4 hours Chapter 43 - Page 571
How do cementless versus cemented hemiarthroplasty compare in the treatment of elderly hip fractures?
Cemented stems are recommended because of less pain and complications Chapter 31 - Page 404
How are type II acetabular defects usually reconstructed?
Cementless acetabular component with adjuvant screw fixation and morselized cancellus bone grafting of contained defects Acetabular revision on right with impacted morselized cancellus bone grafting and adjuvant screw fixation Chapter 32- Page 423
What is the treatment of choice with a complete ACL injury in a growing child with a Tanner scale equal or greater to 3?
Central tunnel trans-physeal given limited residual growth Chapter 61 - Page 786
What is the treatment choice of implant for unstable intertrochanteric femur fractures?
Cephalomedullary nail Chapter 31 - Page 405
What is the most common neuromuscular disorder in children?
Cerebral palsy 2 in 1000 births (Incidence has not changed in the last decade) Chapter 63 - Page 811
What is the rationale in using Cethrin therapy in spinal cord injury patients?
Cethrin is a Rho Antagonist Applied directly to the cord ( axonal growth cone) Promotes growth of the axonal growth cone When Rho is exposed to myelin molecules it becomes regulatory. This conversion is blocked by Cethrin Chapter 44 - Page 576
Children who present with dysplasia late and have a broad-based gait, what disorder should be considered and ruled out?
Charcot-Marie-Tooth Broad-based gait of Charcot-Marie-Tooth, can be a source of peer ridicule Chapter 63 - Pages 819-820
What is the Dial test and how is it performed?
Checks for posterolateral rotatory instability, check knee at 30 and 90 degrees of flexion Chapter 35 - Page 455
What should the orthopaedist be concerned about when treating children less than 2 years old with transphyseal humeral fractures?
Child abuse (50% of cases) Chapter 53 - Page 681
What is the radiologic terminology when there is calcification with calcium pyrophosphate crystals of articular cartilage and or meniscus?
Chondrocalcinosis Chapter 18 - Page 220
What is Sinding-Larsen-Johansson syndrome?
Chronic apophysitis inferior pole of patella Sinding-Larsen-Johansson: MRI reveals thickening of the patellar tendon, irregular ossification of the inferior pole of patella and focal heterotopic ossification within the patellar tendon (short black arrow) Chapter 61- Page 794
The exact etiology for juvenile osteochondritis dissecans is not known. What theory is most accepted?
Chronic repetitive microtrauma Males 3:1 over females but increased prevalence in females given increase in participating in sports (increased prevalence in younger patients given increased participation in sports) Chapter 61 - Page 791
What is the Larsen classification?
Classification used to stratify elbow joint involvement in rheumatoid arthritis. I normal architecture and osteoporosis, synovitis II joint space narrowing and intact joint architecture, synovitis III alteration of joint architecture IV gross joint destruction Chapter 27 - Page 343
What procedure has been proven effective if done early enough following surgical contraction releases?
Closed manipulation under anesthesia (Study of 51 patients manipulated on average 40 days after surgery. The mean range of motion arc increased from 40°, preoperatively to 78°) Chapter 27 - Page 344
What is the treatment for a transphyseal fracture?
Closed reduction and pinning (Higher rate of cubitus varus with casting only) Chapter 53 - Page 681
What organism are you concerned about with soil contamination?
Clostridium Chapter 5 - Page 50
In using the Dial Test with the knee at 90 degrees of flexion, what ligamentous instability is indicated by an increase in external rotation by 10-15 degree?
Combined PLC +PCL injury Chapter 35 - Page 455
What procedures are indicated when there is sufficient soft tissue restraints and increased extensor mechanism valgus alignment?
Combined procedures Chapter 35 - Page 461
What can improve the rate of fusion in a Talonavicular arthrodesis or talonavicular cuneiform arthrodesis (both for talonavicular arthritis)?
Combined with a subtalar fusion (results in more limited foot motion) Chapter 40 - Page 525
In most hips with OA, the pattern of wear is superior and lateral. Medial OA is most commonly seen in which subgroup of patients on plain radiographs?
Commonly in women with underlying coxa profunda Coxa Profunda, global overcoverage Chapter 32 - Page 414
What is a systematic review (levels I II and III)?
Comprehensive literature search to identify studies appropriate for answering a particular clinical question Chapter 14 - Page 159
Rotational osteotomies are performed in radialulnar synostosis to position the arm in a more favorable position. What position in both arms is best for computer use? What position of the nondominant side may facilitate perineal care?
Computer use: Bilateral slight pronation Perineal care: Nondominant in supination Chapter 55 - Page 706
The P value does not take into account the quantitative treatment effect or if the difference is clinically significant. What parameter indicates the probability of committing a type I error and additionally includes the size of the treatment effect and clinical significance?
Confidence interval Green area equals confidence level Chapter 15 - Page 173
In proximal femoral replacement with allograft, dislocation is common because of lack of proper attachment of the abductors. What should be considered with the acetabular side to prevent dislocation?
Constrained acetabular liner Constrained acetabular liner Chapter 32 - Page 426
What is the most important imaging modality for the evaluation of arthritis?
Conventional Radiography Weight bearing views are of value, particularly for the dynamic evaluation of joint space in the hip, knee and ankle Chapter 8 - Page 85
With open rotator cuff repair, how is the coracohumeral ligament managed?
Coracohumeral ligament is released if it is tight (initially palpated with external rotation and adduction) Coracohumeral ligament Chapter 24 - Page 306
For primary bone tumors and soft tissue sarcomas which needle biopsy is more accurate, fine needle aspiration or core needle biopsy?
Core needle biopsy Chapter 8 - Page 102
What fracture pattern in children should immediately prompt suspicion of abuse?
Corner fracture- small peripheral metaphyseal fragment Often seen at distal femur and proximal and distal tibia Chapter 59 - Page 753
Which boney structure often needs reconstruction in chronic complex elbow dislocation?
Coronoid (guarded prognosis if bone loss exceeds 50%) Chapter 27—Page 348
What is the concern of modular femoral components?
Corrosion at modular junction-> increased osteolysis Osteolysis distal to modular junction Chapter 32 - Page 423
Is cortical bone stronger in tension or compression and why is this property important with fracture patterns of the femur?
Cortical bone is 50% stronger in compression compared to tension. Fracture are initiated where there is high tensile stress and have predictable fracture patterns Chapter 6 - Page 61
Distal femoral metaphyseal fractures proximal to the growth plate are unstable, how should these be treated?
Crossed smooth K wire fixation (Avoid passing wires through physes if possible) Chapter 59 - Page 753 .
In the past it was felt that a scoliotic curve greater than 45° could progress after maturity. Currently, the thinking is that what predicts future curve progression?
Current documented history of progression Chapter 45 - Page 585
Which femoral stem design is proximal stress shielding most often associated with?
Cylindrical fully porous coated cobalt chromium stems with a beaded surface fully porous coated, parallel-sided, diaphyseal-engaging stem. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 423 Chapter 32 - Page 422
What is the risk of peroneal nerve damage with a knee dislocation?
25% Chapter 35 - Page 458
Can a subacromial cortisone injections interfere with rotator cuff healing after repair?
Yes Chapter 24 - Page 306
What are other contributing factors to lateral patella subluxation?
- Patella alta - ↑femoral anteversion - Internal tibia torsion - Core and hip abductor weakness Chapter 35 - Page 461
What is the current practice on use of methylprednisolone in spinal cord injuries?
- Use is debated in clinical and scientific literature. - Used to be standard of care. - Recent systematic review of animal studies demonstrated no benefit in 58% of studies. - Canadian survey shows that most providers do not use it for treatment of acute SCI. - Most providers in the US continue to use it due to fear of litigation. Chapter 44 - Page 576
Stiffness of a plate is related to width x thickness. Increasing the width and thickness increases the strength to what power? Doubling the plate's thickness results in what change in the stiffness?
-The 1st power for plate width The 3rd power for plate thickness Doubling the plates thickness results in 8 times the stiffness Chapter 6 - Page 61
What two X-ray views besides AP and lateral views help identify OCD of the knee?
1. Axial view (patella and trochlea lesions) 2. Notch view (posterior femoral condyle) Chapter 61 - Page 791
The ischemic index, using arterial Doppler ratio compared to brachial systolic pressure indicates good healing at and above what level?
0.5 or greater indicates good healing potential Chapter 41 - Page 538
What are two indications for surgical repair of a displaced tibial tubercle fracture?
1. Intra-articular fracture 2. Displaced more than 2 mm Chapter 59 - Page 756
What percent of studies in orthopaedic literature are Level 4?
54-58% Chapter 14 - Page 160
What two criteria defines a tibial shaft fracture nonunion?
1. No fracture healing at 6 months 2. No progressive healing for 3 consecutive months Chapter 37 - Page 486
Who does Rheumatoid Arthritis (RA) affect?
1 - 1.5 % of the world population 3 times more women than men Chapter 18 - Page 217
What are five common physical exam findings and tests with valgus instability?
1 Tenderness at the medial collateral origin 2. Tenderness at the posterior medial olecranon (valgus extension overload) 3. Valgus stress test—elbow in 30 degree flexion 4. Milking maneuver—elbow at 90 degrees 5. Moving valgus stress test—reproducible pain over MCL origin in 70-120 degree arc Milking maneuver Chapter 27 - Page 346
What is the risk of viral transmission with an allograft?
1 in 1.6 million Chapter 35 - Page 454
What are two best ways of diagnosing a posterior shoulder dislocation radiographically?
1. Axillary view 2. CT scan Axillary view, C. = coracoid; double arrow = glenoid; single arrow reverse Hill-Sachs lesion Chapter 24 - Pages 302-303
What is the treatment for medial epicondyle fractures displaced less than 5 mm?
1-2 weeks of cast immobilization Chapter 53 - Page 681
With high energy displaced femoral neck fractures in young patients, an anatomic reduction of the femoral neck must be obtained, sometimes requiring which two approaches?
1. Anterior (Smith Peterson) 2. Anterior Lateral (Watson-Jones) Chapter 31 - Page 404
What four radiographic clues raise suspicion for posteromedial rotatory instability?
1. 'Double density' of the coronoid subchondral plate on lateral images 2. Narrowing of the anteromedial ulnohumeral joint space on AP images 3. Varus stress radiographs may highlight LCL insufficiency and show trochlear coronoid contact. 4. CT scan can help identify the anteromedial coronoid fracture and confirm the diagnosis. A.: Residual subluxation of elbow after reduction with "double density" of coronoid B, C..: External Rotation of distal humerus into anterior medial coronoid fracture defect with anterior subluxation D.: Postop X-ray Chapter 27 - Page 346
What is the average largest diameter acceptable for a Sural flap?
6 cm Chapter 5 - Page 53
What are two characteristics of vertebral column resection?
1. 1 or more vertebral segments are removed, Including vertebral body, pedicles and posterior elements. 2. Discs are removed above and below Sagittal Plane Deformity in the Adult Patient Samuel A. Joseph, et al. J Am Acad Orthop Surg June 2009 ; 17:378-388.
What are three characteristics of Camptodactyly?
1. 1% of population 2. Flexion contracture of PIP 3. Little finger most common Chapter 55 - Page 705
What are four components of a high quality randomized controlled trial?
1. Appropriately powered 2. Use appropriate randomization technique 3. High rate of follow up 4. Triple blinded Chapter 14 - Page 159
What are two procedures for early hip subluxation in the younger CP child?
1. Adductor release, psoas release 2. Abduction pillow Chapter 63 - Page 814
What is the position of the elbow and forearm when securing the graft on the lateral ulnar collateral ligament reconstruction?
1. Arm in neutral position 2. 45° of flexion at the elbow Chapter 27 - Page 346
What are the seven risk factors for OA?
1. Advancing age 2. Female gender 3. Genetic mutation in the FRZB gene which codes for the frizzle protein causes abnormal cartilage matrix synthesis and joint development 4. Abnormal joint anatomy increasing focal joint stress 5.Trauma 6. Increased BMI (stronger risk factor with females) 7. High bone density Chapter 18 - Pages 214-215
Who is the ideal candidate for a periacetabular osteotomy for hip dysplasia? Name five characteristics.
1. Age less than 40 2. Tonnis 0 or 1 OA 3. Poorly covered head 4. Round head and round acetabulum 5. Not obese Chapter 32 - Page 418
What are four characteristics of the nucleus pulposus?
1. Aggrecan and type II collagen matrix 2. Cells derived from notochord 3. Large vacuoles in the cells 4. Prominent cytoskeletal elements Chapter 3 - Page 28
How does aging versus degeneration of the disc affect metabolic transport?
1. Aging: decreases metabolic transport, calcification the endplate diminishes solute transport 2. Degenerative changes and end plate disruption: increases solute transport Chapter 3 - Page 29
What two mechanisms of injury often lead to significant morbidity (including amputation) in children?
1. All terrain vehicle accidents (degloving injury from being caught in the chain mechanism) 2. Lawn mower accidents. (Frequent debridements and soft tissue flaps Chapter 59 - Page 759
Young people may develop stress fractures of the femoral neck without trauma. What are two groups at risk?
1. Amenorrheic women 2. Marathon Runners Chapter 31 - Page 404
What are four diagnosis included in the differential diagnosis of neonatal compartment syndrome?
1. Amniotic band 2. Cord strangulation 3. Arterial thrombosis 4. Cellulitis Chapter 55 - Page 711
What are four determinations of surgical treatment of sagittal imbalance?
1. Amount of positive sagittal imbalance 2. Amount of flexibility of the deformity 3. If kyphosis is focal (posttraumatic) or multilevel (i.e. Scheuermann's kyphosis) 4. Amount of pelvic incidence Chapter 45 - Page 590
What are three other parameters measured in nerve conduction besides latency and conduction velocity?
1. Amplitude of the response 2. F-wave response 3 H-reflex study Chapter 19 - Page 229
What are two pathologic findings of diabetic neuropathy?
1. Axonal degeneration with small regenerated axons 2. Segmental demyelination Chapter 19 - Page 231
What are two results from the low oxygen tension in the center of the aging disc?
1. Anaerobic metabolism leading to high pH and lactic acid 2. Nucleus pulposus cells become quiescent (inactive) Chapter 3 - Page 30
What are two broad categories of lateral ankle ligament reconstruction and which type is preferred?
1. Anatomic and non-anatomic 2. Anatomic is preferred Chapter 40- Page 529
When can a radial neck fracture be treated by immobilization for 2-3 weeks followed by gradual return to function?
1. Angulation is less than 30 degrees 2. Translation is less than 3 mm to 5 mm. Chapter 53 - Page 682
What are two options for failed ankle arthrodesis?
1. Ankle Arthroplasty ( requires Intrinsic coronal plane stability) 2. Repeat Arthrodesis ( if failure originally from poor fixation technique or correctable issues) Chapter 40 - Page 525
What are the two most common definitive surgical treatment options for severe ankle arthritis?
1. Ankle arthroplasty 2. Ankle arthrodesis Chapter 40 - Pages 524 - 525
What is the radiographic hallmark of vertebral osteomyelitis with mycobacterium tuberculosis and why?
Disk space sparing because it is resistant to infection Chapter 43 - Page 567
Spine surgery longer than____hours and blood loss greater than____liter(s) has a higher risk of infection.
1. 3 hours 2. 1 L of blood loss Chapter 43 - Page 570
What two results were shown when comparing negative pressure wound management set at 125 mmHg continuous and intermittent to a wet to dry dressing?
1. 4 fold increase in blood flow 2. 63% increase in granulation tissue with continuous and 3.103% with intermittent pressure Chapter 5 - Page 52 Chapter 5 - Page 53
When using a spica cast for pediatric femur fractures, what is the ideal position of the hip and knee?
1. 60-90 degrees hip flexion (increase flexion for more proximal femur fractures) 2. Up to 90 degrees knee flexion 3. 30 degrees hip abduction (Some external rotation will correct rotation deformity of the distal fragment) Chapter 57 - Page 732
What are the 3 acceptable reduction requirements of early spica cast application for pediatric femur fractures?
1. <10° of angulation in the coronal plane 2. <20° of angulation in the sagittal plane 3. Less than 2 cm of shortening Chapter 57 - Page 732
What are three late indicators of a dislocated hip on physical exam?
1. A positive Galeazzi sign 2. Asymmetric thigh folds 3. Decreased hip abduction Galeazzi sign Chapter 58 - Page 740
A recent study revealed that surgically treated unilateral fracture-dislocation had better outcomes than non-surgically treated in regard to pain and functional scores. What are three surgical treatment options?
1. ACDF (anterior cervical discectomy and fusion) with locking plate fixation 2. Posterior foraminotomies and arthrodesis using bone graft 3. Segmental stabilization with screw and rod construct Chapter 48 - Pages 633-634
What five agents are recommended for VTE prophylaxis for patients undergoing an elective THA or TKA and a normal risk of both PE and major bleeding?
1. ASA 2. LMWH 3. Fondaparinux 4. Warfarin (INR equal or less than 2) 5. Consider mechanical prophylaxis, rapid post op mobilization and patient education of the symptoms of VTE as well. Chapter 12 - Page 141
What are two causes of valgus instability?
1. Acute trauma (dislocation) 2. Repetitive microtrauma (throwing athlete) Chapter 27 - Page 346
What are three characteristics of Anterior Cord Syndrome?
1. Anterior aspect of cord is affected 2. Motor, light touch and pain are impaired. 3. Deep pressure, proprioception and vibratory sensation intact Chapter 44 - Page 575
In what two ways does surgical treatment of tarsometatarsal joint arthritis vary between the medial and lateral columns of the foot?
1. Arthrodesis of the first, second and third metatarsal-cuneiform joints results in minimal significant functional limitations. 2. The fourth and 5th MT-cuboid joints are treated with tissue or joint arthroplasty and never with arthrodesis Chapter 40 - Page 525
At 7 weeks gestation a cleft develops between the future femoral head and acetabulum. By 11 weeks the hip joint is fully formed. Teratologic dislocations occur in neurologic and genetic syndromes particularly where there is very little fetal movement. Give 2 syndromes where there is an increased risk of teratologic dislocation.
1. Arthrogryposis 2. Spina bifida Embryo 11 weeks with fully formed hip Embryo measures 46 mm (crown to rump) Chapter 58 - Page 739
What are two operative treatment strategies for young patients with elbow osteoarthritis?
1. Arthroscopic debridement and synovectomy 2. Debridement and interpositional arthroplasty Chapter 27 - Page 343
The pathophysiology of chronic compression of nerves is different from acute crush and severance injuries. What are five characteristics that are hallmark of chronic nerve compression?
1. Axonal integrity maintained 2. Demyelination and remyelination (leads to thinner myelin) 3. Slowing nerve conductance velocities 4. Schwann cell phenotype switch to nonmyelinated and Remak bundles 5.Remak bundles have increased number of C fibers (unmyelinated) therefore slower conductance Chapter 19 - Page 229
The new classification of coronoid fractures has helped to better understanding recurrent instability of the elbow. What are three classifications?
1. Basal 2. Anterior medial 3. Tip Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, pp 345 Chapter 27 - Page 345
What are three components of evidence-based practice?
1. Best available evidence 2. Patients' values and preferences 3. Clinical expertise Chapter 15 - Page 173
Ulnar longitudinal deficiencies are not usually associated with other organ systems but are associated with skeletal abnormalities. Give three examples.
1. Bilateral ulnar longitudinal deficiency (25%) 2. Preaxial abnormalities (fibular hemimelia) 3. Proximal Focal femoral deficiency Chapter 55 - Pages 700-701
What three muscles impart compressive forces across the joint therefore stabilizing the elbow joint?
1. Brachialis 2. Triceps 3. Anconeous. Chapter 27 - 344
What are two clinical conditions that are associated with hypothyroidism?
1. Carpal tunnel (common) 2. Generalized sensory polyneuropathy (rare) Chapter 19 - Page 232
What three treatments have proven to be effective to prevent posttraumatic chondrocyte death?
1. Caspase Inhibitor a. Casepase aka "the executioner"- protenase responsible for normal cell death b. Caspase inhibitors can prevent 50% of chondrocyte death in human ankle after blunt trauma c. Pan-caspase inhibitor Z-VAD-FMK 2. P-188 a. Also prevent 50% chondrocyte death b. Restoring cell membrane integrity 3. BMP-7 a. Intra-articular injection in sheep Chapter 3 - Page 26
Give four examples of dichotomous outcomes.
1. Death 2. Nonunion 3. Infection 4. Revision surgery Chapter 15 - Page 167
Name three clinical benefits from NPWT (negative pressure wound treatment) when applied to combat related soft tissue defects and high energy open fractures.
1. Decreasing time required for soft tissue closure (NPWT used to bridge the gap between debridements and closure) 2. Decreasing the amount of tissue needed to be debrided 3. Decrease bacterial counts and the probability of infection (20% reduction in infection rate) Chapter 5 - Page 52
What are two nerve conductance findings with a conduction block?
1. Delay in conduction velocity 2. Decreased amplitude from across the injury Occurs with complete or incomplete disruption of conductance (neurapraxia) Normal distal response but abnormal as stimulator is moved proximal to the side of injury Chapter 19 - Page 229
What are two advantages of bracing scoliosis with meningomyelocele?
1. Delay surgery until the child is older 2. Improves sitting balance Chapter 63 - Page 816
What are two electrodiagnostic findings of demyelinating lesions?
1. Delayed latency 2. Slower nerve conductance (Amplitude diminished only if there is a severe conduction block) Chapter 19 - Page 230
What are seven early signs of Duchenne muscular dystrophy?
1. Delayed walking 2. Weakness or "laziness" 3. Waddling gait 4. Difficulty hopping or climbing stairs 5. Positive Gower's sign (uses arms and hands to raise themself up off the floor to a standing position) 6. Pseudohypertrophy of the calf muscles 7. Lumbar lordosis Chapter 63 - Page 818
What is the classification used for pediatric femoral neck fractures? Identified all 4 types.
1. Delbet Type 1 Transphyseal separation 2. Type 2 Transcervical 3. Type 3 Basicervical 4. Type 4 intertrochanteric Chapter 57 - Page 731
What are three steps in assigning level of evidence to a particular study?
1. Determine the primary research question 2. Establish the study type 3. Assign a level of evidence Chapter 14 - Page 157
What are three diagnoses that could result in posterior lateral rotatory instability?
1. Elbow dislocation with attenuated lateral ulnar collateral ligament complex (most common) 2. Iatrogenic following lateral epicondylar release 3. Chronic cubitus varus malunion with progressive ligament attenuation Chapter 27 - Page 345
What four infectious disease disorders are associated with acute polyarticular septic arthritis?
1. Endocarditis 2. Rheumatic fever 3. Neisseria 4. Acute hepatitis B Chapter 18 - Pages 220-221
What four conditions happen as the nucleus pulposus ages?
1. Fragmentation of proteoglycans in the nucleus fragment 2. Collagen content (especially type I) increases, leading to a more fibrous structure 3. Degraded proteoglycan leak out resulting less fluid retention and less hydrostatic pressure 4. Decreased matrix turnover (secondary to diminish cellularity an increase cross-linking, collagen fibers) Chapter 3 - Page 29
What are four lobes (gray matter) of the brain? What is the general function of that part of the brain?
1. Frontal: Execution of executive and affective functions 2. Temporal: Memory and cognition 3. Parietal: Motor and sensory 4. Occipital: Vision Chapter 19 - Page 226
In cognitively impaired patients, it is recommended to use a three-phase protocol for cervical spine clearance. Please give the three phases.
1. Helical CT of the entire cervical spine with sagittal and coronal re\re formation SHOULD BE REFORMATION 2. Second review of all spine images after clinical evaluation (if previous studies negative) 3. Upright lateral C-spine (if previous studies negative) Presence of new onset of deformity Chapter 48 - Page 624
What are three sources for epidural abscess?
1. Hematogenous (50%) 2. Discitis (33%) 3. Not identifiable (22%) Epidural abscess in diabetic Chapter 43 - Page 570
Name four anatomic classifications of cerebral palsy.
1. Hemiplegia-ipsilateral upper or lower extremity involvement and trunk 2. Quadriplegia or tetraplegia-all 4 extremities involved and trunk 3. Diplegia-lower extremities greater than upper extremity involvement (most common) 4. Monoplegia-single limb involvement (rare) A report: The definition and classification of cerebral palsy April 2006". Developmental Medicine & Child Neurology 49: 8-14. 2007. doi:10.1111/j.1469-8749.2007.tb12610.x. Chapter 63 - Page 812
What two epigenic (genetic changes without altering the sequence) modifications lead to osteoarthritis and are targeted for future treatment?
1. Histone modification a. Histones are proteins that act as spools around which packages of DNA (chromatin) wraps around therefore are involved in gene regulation. b. Histone acetylase/deacetylase -add/remove acetyl group from lysine on the histone resulting in less tightly/more tightly wrapped DNA and more transcription/gene silencers c. Histone acetylase/deacetylase inhibitors inhibit the expression (less transcription) of MMP and ADAMTS and prevent osteoarthritis. 2. DNA Methylation a. addition of a methyl group to cytosine ( pyrimidine ring) or adenine (purine ring) cytosine and adenine are two of the four bases of DNA. b. DNA methytransferase removes the methyl group from cytosine and adenine resulting in matrix degradation and osteoarthritis A. Schematic mechanism of DNA methylation, C. Schematic mechanism of histone acetylation/deacetylation showing the condensed chromatin and gene silencing, then the expanded chromatin with gene transcription. Histone deacetylase inhibitors modulate metalloproteinase gene expression in chondrocytes and block cartilage resorption David A Young Chapter 3 - Page 25
Name five patterns of a meniscal tear.
1. Horizontal 2. Radial 3. Flap 4. Longitudinal 5. Bucket-handle (unstable longitudinal) Chapter 35 - Page 459
Fractures in meningomyelocele can be complex and mimic infection with a warm swollen limb, leukocytosis, fever and increased sedimentation rate. Thoracic level meningomyelocele had a 70% fracture rate and 50% refracture rate. What two approaches can be done to minimize this refracture rate?
1. Immobilized for a minimum amount of time 2. Return to baseline weight bearing as quickly as possible Radiograph showing a thoracic-level myelomeningocele in a patient who sustained a femur fracture. Note the prolific amount of callus formation. Arrows point to the gracile( small slender) femoral cortices. Fractures in this patient population can be suspicious for infectious process, with a red, swollen knee the presenting complaint. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 818 Chapter 63 - Page 818
CT evaluation of the cervical spine is recommended for patients with what seven situations? (acronym - I CAN HELP)
1. Impaired Cognitive status 2. History of Ankylosing spondylitis 3. Focal Neurologic findings 4. Head trauma (Craniofacial) 5 High Energy trauma (fall greater than 10 feet, MVA speed greater than 30 miles per hour or associated death at the scene) 6. Long bone fractures 7. Pelvic fractures Chapter 48 - Page 624
How do glucocorticoids modify muscular dystrophy? Give four examples.
1. Improve muscle strength 2. Prolong walking 3. Slow the progression of scoliosis 4. Delay need for surgery Comprehensive management for muscular dystrophy Chapter 63 - Page 818
What are the seven proposed mechanisms of negative pressure wound therapy systems?
1. Increase local blood flow 2. Reduce edema 3. Stimulate formation of granulation tissue 4. Stimulate cell proliferation by release of growth factors stimulated by mechanical strain 5. Reduce cytokines 6. Reduce bacterial load 7. Draw wounds together Chapter 5 - Page 51
The diagnosis of compartment syndrome in children is more difficult than adults. What are three additional signs of pediatric compartment syndrome.
1. Increased Anxiety 2. Increased Agitation 3. Increased Analgesics i.e. narcotics The "3 As" Chapter 59 - Page 757
What are four indications for a limited laminectomy in adult scoliosis?
1. Leg pain only 2. Lumbar curve less than 20° and minimum rotation 3. No radiographic instability (less than 4 mm of motion on dynamic radiographs and less than 2 mm lateral translation) 4. No significant sagittal or coronal imbalance Chapter 45 - Page 589
What are three considerations when determining length of residual limb?
1. Length of usable lever arm which determines power available for ambulation 2. Remaining space for components 3. Cosmetic appearance Chapter 41 - Page 538
What are the four acceptable displacement ranges of a tibial shaft fracture?
1. Less than 50% cortical displacement 2. Angulation less than 5-10 degrees 3. Rotation less than 10 degrees 4. Less than 1cm shortening Chapter 37 - Page 48
There is a new understanding that obesity has an impact on children with neuromuscular disorders. Give three issues that are a result of obesity.
1. Obesity is less tolerated in patients with neuromuscular disorder 2. Muscle weakness is more difficult to diagnose in obese children because the loss of muscle volume is replaced by adipose tissue giving a more normal appearance to the limbs 3. Obesity may give a normal prediction of weight on standard growth curve Chapter 63 - Page 811
What are four other contributing factors to lateral patella subluxation?
1. Patella alta 2. ↑femoral anteversion 3. Internal tibia torsion 4. Core and hip abductor weakness Chapter 35 - Page 461
What two structures cause the deforming forces seen in a proximal third tibial shaft fracture?
1. Patellar tendon 2. Iliotibial band Chapter 37 - Page 482
In MDI, there is no history of acute trauma or true shoulder dislocation. Multidirectional instability can result from what four causes?
1. Poor technique during athletic activity 2. Genetics (Ehlers-Danlos) joint laxity 3. Poor scapulohumeral mechanics 4. Rotator cuff dysfunction Physical findings of joint laxity with Ehlers-Danlos Chapter 24 - Page 303
Madelung's deformity usually does not require surgical intervention because the deformity is well tolerated. What two early procedures can be done to prevent progressive deformity?
1. Release of Vickers ligament 2. Physiolysis of the distal ulnar aspect of the distal radius Preoperative X-rays of Madelung's deformity Chapter 55 - Page 711
What are three goals of adult scoliosis surgery?
1. Relief of leg and back pain 2. Curve stabilization 3. Achievement of spinal balance Chapter 45 - Page 588
What are three treatment goals for either arthroscopic or open repair of recurrent posterior shoulder dislocation?
1. Repair posterior labrum 2. Repair any capsular tears 3. Reduce volume posterior capsule Surgical steps of repair of ruptured posterior capsule Chapter 24 - Page 303
What are two major failures of osteochondral allografts?
1. Resorption 2. Fragmentation Chapter 40 - Page 526
What is Becker muscular dystrophy?
1. Similar to Duchenne but less severe 2. Also X-linked recessive (only seen in males) The genetics of X-linked recessive disorders Chapter 63 - Page 818
Recent studies show that calcium intracellular flux (the primary effect of mechanical strain) is mediated by what in maintaining cartilage hemostasis?
1. Single cilia attached to stretch activated channels on the cell membrane. The cilia extends into the peri-cellular matrix. This cilia it works like a toggle switch. If the cell does not have it cilia then degeneration. The tip of the cilia has collagen VI fibrils attached to it. With loading such as walking the cilia is compressed activating the calcium intracellular flux Chapter 3 - Page 24
In the nonambulatory CP patients subluxation or dislocated hips can lead to what four difficulties?
1. Sitting 2. Hygiene 3. Windswept deformity 4. Painful Chapter 63 - Page 814
What three factors are utilized to grade open fractures in the Gustilo and Anderson Classification system?
1. Size of open wound 2. Degree of contamination 3. Fracture severity Gustilo and Anderson Classification of Open Fractures Fracture Type Characteristics Type I Wounds less than 1 cm; minimal contamination and soft-tissue injury; simple fracture pattern Type II Wounds 1 to 10 cm; moderate comminution and contamination Type IIIA Minimal periosteal stripping and soft-tissue coverage required Type IIIB Significant periosteal stripping at the fracture site; soft-tissue coverage required Type IIIC Indicates an associated repairable vascular injury Chapter 37 - Page 480
What five types of biceps pathology require either tentotomy or tenodesis?
1. Subluxation 2. Fraying 3. Tenosynovitis 4. Insertional detachment 5. Hypertrophy Chapter 24 - Page 307
After performing open reduction of a chronic posterior shoulder dislocation, it is found that the shoulder is unstable. What five options are available to stabilize the shoulder?
1. Subscapularis or lesser tuberosity transfer into the reverse Hill-Sachs lesion 2. Osteochondral bone grafting 3. Segmental humeral head replacement 4. Humeral head replacement 5. Iliac crest bone graft for glenoid bone loss Allograft reconstruction of reverse Hill-Sachs lesion Chapter 24 - Page 303
What are two usual X-ray findings of little leaguer's shoulder?
1. Subtle widening of the physis 2. Changes in the metaphyseal bone AP radiograph of both shoulders in an adolescent baseball pitcher demonstrates right proximal humeral epiphyseolysis. (Copyright Intermountain Orthopaedics, Boise, ID.) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 789 Chapter 61 - Page 789
What are three consequences of vertebral artery injury?
1. Sudden deterioration 2. Stroke 3. Death (Ischemia to cerebellum and brain stem) Major factor to determine consequence is the patency of the contralateral non-traumatized vertebral artery. Chapter 48 - Page 636
Which two medications are indicated for treatment of Enteropathic Arthritis?
1. Sulfasalazine 2. Azathioprine & Methotrexate (2nd line) Chapter 18 - Page 219
What are four mechanical steps of posterior lateral instability?
1. Supination 2. Axial loading 3. Valgus stress 4. Extension of the elbow Chapter 27 - Page 345
What are three characteristics of T1-weighted MRI sequences?
1. Take a short time to acquire 2. Highly sensitive for detecting marrow abnormalities 3. Can be used to detect occult hip fractures as a single sequence (Most abnormalities have a low signal intensity on T1 weighted sequences) A lung tumor in a 66-year-old man metastasized to the thoracic spine. A, Lateral radiograph of the thoracic spine is unremarkable except for some degenerative changes. B, Sagittal T1-weighted MRI of the thoracic spine showsan infiltrative process involving the entire vertebral body of T10 with extension into the body of T9 (long arrow). Early involvement of the body of T3 was also suspected (short arrow). Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 95 Chapter 8 - Page 95
What are two limitations of bracing with kyphosis from meningomyelocele?
1. Technically difficult 2. Does not prevent curve progression Chapter 63 - Page 816
What two treatment options are for stage I and adult acquired flatfoot deformity and posterior tibial tendon tendinitis?
1. Tenosynovectomy 2. Tendon repair for intrasubstance or longitudinal tears Chapter 40 - Page 527
The initial dissection is made between what two muscles in the Smith-Petersen approach?
1. Tensor fascia lata (superior femoral nerve) 2. Sartorius (femoral nerve) Initial dissection of the Smith-Petersen approach between tensor fascia lata and Sartorius muscles Chapter 58 - Page 742
What are three important factors that determine a good quality reduction of a SCH fx?
1. The anterior humeral line should bisect the capitellum on the lateral XR. 2. The humeral - capitellar angle should mirror the similar angles on the contralateral, intact, elbow 3. Baumann angle should mirror the similar angles on the contralateral, intact, elbow Humeral capitellar angle Chapter 53 - Page 678
What are three bone graft options following corpectomy to reconstruct the anterior column?
1. Tricortical structural iliac crest graft 2. Structural fibular allograft 3. Structural cage with autologous local bone graft core Tricortical structural iliac crest graft Chapter 48 - Page 633
What are four important radiographic findings when assessing neoplasms that may help to make the diagnosis?
1. Tumor location 2. Tumor border 3. Presence of periosteal reaction 4. Presence of matrix calcification Malignant bone tumor permeative and moth-eaten border Chapter 8 - Page 87
What are three differences seen when comparing nailing to plating of proximal third tibial shaft fracture?
1. Twice as common apex anterior deformity with nailing 2. Three times the rate of hardware removal needed for plating 3. Lower infection with nailing Chapter 37 - Page 483
What are the three ORIF options for femoral head fractures?
1. Two or more 2.7 or 3.5 lag screws countersunk (most common) 2. Headless screws 3. Bioabsorbable screws Chapter 31 - Page 401
Chondrocytes produce what 5 components important in cartilage physiology and degeneration?
1. Type II collagen 2. Aggrecan (proteoglycan with highly negatively charged glycosaminoglycans) 3.Cartlidge breakdown enzymes 4. Cytokines 5. Growth factors Chapter 18 - Page 213
What four technical modifications can help reduce the risk of apex anterior and valgus malunion with anterograde IM nailing of proximal metadiaphyseal tibial fractures?
1. Use of a lateral or posterior blocking or Poller screw 2. Starting point medial to the lateral tibial spine and/or at the anterior margin of the articular surface 3. Use of a medial unicortical plate 4. Use of the semiextended position to relax the patellar tendon Illustration showing the use of a posterior blocking screw (A) and a lateral blocking screw (B) to help maintain alignment of the tibia in both coronal and sagittal planes during nailing of a proximal-third tibia fracture. By keeping the nail against the medial (A) and anterior (B) cortices, deformity is prevented. (Reproduced with permission from Stannard J,. Schmidt A, Kregor P: Surgical Treatment of Orthopedic Trauma. New York, NY, Thieme Medical Publishers, 2007, pp 767-791.) Chapter 37 - Page 482 - Figure 2
What are five risk factors place THA and TKA patients into a high risk VTE group?
1. VTE within the past 5 years 2. CHF class II or III 3. Atrial fibrillation and cardiac disease on warfarin 4. Malignant disease that required recent surgery 5. Hypercoagulable states: factor V Leiden, prothrombin disorders, other hypercoagulable states Chapter 12 - Page 140
At what levels do the TC02 pressure indicates good healing potential and poor healing potential?
1. Value >40 indicates healing potential 2. Value <30 indicates poor healing potential TC 02 pressure monitor Chapter 41 - Page 538
What are two characteristics of T2 -weighted MRI sequences?
1. Water sensitive, therefore lesions containing water show a bright signal, such as bone marrow or soft-tissue edema, tumors, infections, and acute fractures 2. When fat suppression is added, all fat-containing tissues appear black A 73-year-old man presented to the emergency department with right hip pain and inability to bear weight on the right hip. A, AP radiograph of the right hip was unremarkable. B, Coronal T1-weighted MRI of the pelvis shows a fracture line in the right femoral neck (arrow) surrounded by an area of low signal, which represents marrow edema. C, Coronal fat-suppressed T2-weighted image of the pelvis shows the fracture in the right femoral neck (arrow) surrounded by bright signals, which represent marrow edema. Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 95 Chapter 8 - Page 95
Where are two x-ray findings of radioulnar synostosis?
1. Well-formed fusion mass across proximal radius and ulna 2. Radial head dislocation Chapter 55 - Page 706
Name three circumstances when surgical intervention is considered for a Charcot midfoot deformity?
1. When the deformity is unbraceable 2. Persistent or recurring ulceration 3. Insufficient stability such that the foot no longer provides adequate support for gait Photo shows Charcot deformity of the tibiotalar joint and hindfoot. A, CT reconstruction AP view. B, Postoperative lateral radiograph. Chapter 40 - Page 530
What are six phases of throwing?
1. Windup 2. Early cocking 3. Late cocking 4. Acceleration 5. Deceleration 6. Follow-through eORIF Chapter 27 - Page 346
What are the two most common complications of plate fixation of tibial shaft fractures?
1. Wound-healing issues 2. Prominent hardware Chapter 37 - Page 481
What are five contraindications for NPWT (negative pressure wound therapy)?
1. Wounds with necrotic tissue 2. Exposed internal organs 3. Untreated osteomyelitis 4. Coverage over tumors or cancerous tissue 5. Coverage over unexplored fistulae Chapter 5 - Page 52
What are three characteristics of the ideal candidate for a meniscus allograft?
1. Young 2. Minimal cartilage degeneration 3. Normal bone alignment Chapter 35 - Page 459
What are five components of a well designed case series?
1.100% of patients with the same diagnosis 2. Strict inclusion/exclusion criteria 3. A standard treatment protocol 4. Patient follow up at specified time intervals 5. Well defined outcome measures that include clinical parameters/validated patient derived functional assessment instruments Chapter 14 - Page 159
How much is the patient's hemoglobin lowered on average after donating each unit of autologous blood?
1.2-1.5 g/dL Chapter 12 - Page 141
What are the three functions of the Zone of polarizing activity ?
1.Anterior-posterior differentiation 2. Radial Ulnar differentiation 3. Longitudinal growth. Schematic drawings showing the development of limb bud in a proximal to distal direction coordinated by the apical ectodermal ridge Chapter 55 - Page 697
How quickly after their injury should elderly patients with hip fractures undergo surgical treatment of their fractures?
1.As soon as possible (Delay in surgery increases mortality and morbidity) 2. Patients who do not need medical optimization should be operated on within 2-4 days 3. Patients who require medical optimization should be operated on as soon as their medical condition is as good as it is going to get. Chapter 31 - Page 403
What is the outcome of young patients with femoral neck fractures dependent on what three factors?
1.Fracture comminution 2.Accuracy of the reduction 3.Stable Fixation
What are two important areas in the examination regarding the hips and knees in adult scoliosis with fixed sagittal imbalance?
1.Knee should be fully extended when evaluating standing balance 2. Rule out hip flexion contracture Chapter 45 - Page 585
What are the three classifications of anterior hip dislocation?
1.Obturator 2. Iliac 3. Pubic Chapter 31 - Page 400
What is the lateral pivot shift test? Is it reliable in an awake patient?
1.Provocative test to identify posterolateral rotatory instability 2. Not reliable in an awake patients and more reliable under anesthesia Photo demonstrates the pivot shift test. Chapter 27 - Page 345
What is the genetic predisposition to degenerative disc disease?
29% to 74% Based on studies of twins Implicates polymorphism (different phenotype over time depending on other factors) Chapter 3 - Page 31
In clinodactyly, how much angulation occurs to interfere with ADLs?
30-40° Chapter 55 - Page 705
How soon after an insult can an MRI become positive for AVN?
24 hours (Mean of 3.6 months after initiation of steroid use) Chapter 32 - Page 420
What is the target INR when Warfarin is used for prophylaxis in patients undergoing elective THA and TKA?
2.5 with a range of 2.0-3.0 Coumadin is an oral vitamin K antagonist. Based on the American College of Chest Physicians Guidelines there is grade 1A data supporting its use for prophylaxis in TKA and THA patients Warfarin decreases concentration of Factors that require Vit K for synthesis. II, VII, IX and X therefore Protime Chapter 12 - Page 138
Based on free body diagram calculations, what are approximate loads on the hip joint during walking and running in terms of body weight?
2.7 times body weight in walking 5.2 times body weight in running Chapter 6 - Page 63
Based on free body diagram calculations, what are approximate loads on the knee joint during walking and stair descending in terms of body weight?
2.8 times body weight in walking 3.5 times body weight in stair descending Chapter 6 - Page 63
What percentage of Charcot-Marie-Tooth, type 1 patients have distal weakness in the upper extremity?
2/3rds will have distal weakness and atrophy of the arms Most severe-claw hand deformity Claw hand deformity Charcot-Marie-Tooth Chapter 19 - Page 235
What is the major complication rate in patients older than 60?
20% Chapter 45 - Page 592
Stannard etal. in 2009 demonstrated what difference when comparing negative pressure wound management to gauze dressing in the treatment of severe open fractures?
20% less likely to develop an infection Chapter 5 - Page 52
What migration percentage of the hip will indicate that dislocation will occur in CP patients?
60-70 % migration percentage Chapter 63 - Page 814
Larger femoral heads allow for increased range of motion before impingement. Component to component impingement is eliminated with femoral heads larger than what diameter?
36 mm Chapter 32 - Page 426
What percentage of sciatic nerve injuries following posterior hip dislocation recover spontaneously?
60-70% Chapter 31 - Page 401
To what limit is interbody fusion useful in correcting sagittal imbalance?
6 cm-8 cm positive sagittal balance (Anterior lumbar interbody fusion, ALIF-safest approach with larger grafts and cages) Chapter 45 - Page 590
In syndactyly, the shorter digit will tether the longer digit creating contractures and rotational deformities. Most surgeons agree that early separation of border digits is warranted. Release of the thumb and index finger web should be performed by what age?
6 months (allow development of prehensile grasp and pinch patterns) Chapter 55 - Page 704
How are isolated MCL injuries treated?
6 weeks of bracing (Most pull off from the femoral attachment) Chapter 35 - Page 454
To what age does the acetabulum develop?
6 years Chapter 58 - Page 744
Elderly patients are defined as older than 65 years of age. What percentage of fractures occur in this age group from a ground-level fall?
62% Because of the low-impact mechanism and widespread spondylosis with deformity many fractures are overlooked. Chapter 48 - Page 636
When performing THA for DDH, what is the maximal limb lengthening deemed to be safe?
3.5 cm Chapter 32 - Page 419
What delta P value (difference between the patient's diastolic blood pressure and the intracompartmental pressure) indicates the need for fasciotomy?
30 mm Hg Chapter 37 - Page 479
The exact relationship between the number of hours that a hip is dislocated and its relationship to the development of AVN is still controversial. However, it is believed that the AVN rate increases with dislocation time. What is the critical time?
6-12 hours It is recommended that hip dislocations be reduced as soon as possible after the initial care of life threatening injuries. Chapter 31 - Page 400
What percentage of post fracture deaths are caused by hip fractures in the United States?
50% About 4% of all post injury deaths in the U.S. are caused by hip fractures. By 2040, is it estimated that there will be 500,000 hip fractures/year in the U.S. Chapter 31 - Page 399
What is the incidence of sciatic nerve injury after posterior dislocations and what division is at most risk?
50% Peroneal nerve division is most commonly affected. Chapter 31 - Page 401
How common are constitutional symptoms including fever and malaise in patients with vertebral osteomyelitis?
50% of patients Chapter 43 - Page 566
What is the recurrence rate for dislocation in patients age 20 or less?
50%-80% Chapter 24 - Page 301
Skeletally immature patients with no signs of instability on MRI are more likely to respond to nonsurgical treatment. What is the success rate of nonsurgical treatment?
50%-94% success rate Recent study in 2008, found that the strongest prognostic predictor was the size of the lesion on MRI Chapter 61 - Page 791
What percentage of growth of the femur and the lower extremity occurs at the distal femur?
70% of the femur 40% of the extremity Chapter 59 - Page 754
How should a child with a supracondylar fracture and absent radial and ulnar pulses be managed?
A patient with a white hand: the vascular surgical team should be prepared to explore and repair or reconstruct the brachial artery after reducing and pinning the fracture. A patient with a pink hand should undergo closed reduction and pinning. A near anatomic reduction without gapping should be obtained to avoid avoid artery entrapment. If acceptable closed reduction cannot be obtained, anterior approach should be used for open reduction and to visualize the brachial artert Anatomy of the antecubital area Chapter 53 - Page 679
What imaging should be obtained after a closed reduction of a hip dislocation?
A plain AP pelvis film to check that the hip is reduced and that the reduction appears to be concentric. If it is a CT scan should then be obtained to check for intra-articular fragments that are too small to be seen on plain films. Chapter 31 - Page 400
What is the minimum amount of positive sagittal balance at which reported worse pain, physical function and self-image?
A positive sagittal balance greater than 5 cm Chapter 45 - Page 587
What finding is associated with the best results following release of the tarsal tunnel?
A space occupying lesion in the tarsal tunnel Chapter 40 - Page 529
What constitutes a high level of follow up in a study?
Above 80% Chapter 14 - Page 159
What are four standard features of a normal pediatric lateral elbow radiograph?
A. The olecranon & coronoid fossae form an hourglass shape B. The humerocapitellar angle is 40 degrees C. The anterior humeral line should bisect the capitellum, except in younger children, where it intersects the anterior 1/3 of the capitellum D. A smooth arc joining the anterior humerus, capitellum and coronoid process should be present. Chapter 53 - Page 676, Figure 2
Anterior decompression allows decompression of what important tract that is important in neurologic recovery?
Anterolateral cortical spinal tracks LCT = lateral cortical spinal tract, ACT = anterior cortical spinal tract, ALCT = anterolateral cortical spinal tract Chapter 48 - Page 631
What surgery is done for congenital trigger finger of the fingers (not the thumb)?
A1 pulley resection in one slip of the flexor digitorum superficialis tendon (anatomic variant with abnormal interconnections between superficialis and profundus) Chapter 55 - Page 710
More than 10 degrees of valgus opening in full knee extension indicates what injury pattern?
ACL,PCL (posterior cruciate ligament),MCL and POL (posterior oblique ligament) Chapter 35 - Page 454
What is an ALPSA lesion?
ALPSA = Anterior Labroligamentous Periosteal Sleeve Avulsion Bankhart lesion that heals along the medial glenoid neck ALPSA lesion resulting in instability Chapter 24 - Page 301
In the Triplane fracture there are different variants, however classically what Salter-Harris classification is usually seen on the AP view and on the lateral view?
AP view: Salter-Harris III Lateral view: Salter-Harris II Chapter 59 - Page 757
How quickly after injury should young patients with displaced femoral neck fractures be operated on?
ASAP but with an experienced surgeon who is comfortable performing an open reduction of the femoral neck fracture since that may be needed to obtain an anatomic reduction. Chapter 31 - Page 403
What is the arm position with an anterior shoulder dislocation?
Abduction and external rotation Chapter 24 - Page 299
The evaluation and treatment of a hypoplastic thumb depends on the stability of the carpometacarpal joint. What procedure should be done with a unstable CMC joint?
Ablation and Pollicization Photo shows Type IIIB thumb hypoplasia before (A) and after (B) thumb ablation and index pollicization Chapter 55 - Pages 700-701
On the AP radiograph of the pelvis, what lines make up the acetabular index and what is the normal value?
Acetabular index = Hilgenreiner (horizontal) and acetabular roof line Normal Acetabular index <25° Acetabular index on right normal hip less than 25° and left dislocated greater than 25° Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 741 Chapter 58 - Page 741
What problems are associated with porcine small intestine submucosal xenograft?
Adverse graft reaction and no improved outcomes (No randomized studies for human dermal allograft showing any benefit but no graft adverse reactions) Human dermal allograft Chapter 24 - Page 307
When should you do a reduction of a cervical spine fracture dislocation in an unresponsive patient? Before or after an MRI?
After 1.One must first confirm the absence of a disc or bone fragment in the canal prior to reducing a fracture dislocation of the cervical spine. 2. If disc or bony fragment in canal then anterior or posterior decompression and instrumentation Chapter 48 - Page 627
What should be the timing of intramedullary nail removal from the proximal femur?
After the physis closure Osteonecrosis can occur also from nail removal Chapter 57 - Page 734
During which ages does Legg-Calve-Perthes disease usually occur?
Ages 4-10 years (Can occur as early as 2 years and as late as teenage years) Chapter 58 - Page 744
Who publishes the international guidelines for evaluation of SCI patients?
American Spinal Injury Association (ASIA) Guidelines Chapter 44 - Page 573
Use of what anti-fibrinolytic agent significantly reduces the need for transfusion in CP scoliosis surgery?
Aminiocaproic acid (Amicar)-analog to amino acids lysine binds plasmin preventing its effect on fibrinolysis Aminiocaproic acid effect on plasmin Chapter 63 - Page 814
How is strain calculated?
Amount of compression divided by the original length (Unit-less measurement) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 59 Chapter 6 - Page 59
Does the incidence of VTE differ between patients who undergo surgery for a spine injury who have, or do not have a spinal cord injury?
An increase in DVT in patients who have a spinal cord injury when compared to those who do not Chemical prophylaxis is suggested as soon as it is "safe." LMWH was more effective than unfractionated heparin with less bleeding complications. Chapter 12 - Page 138
What is the deformity to prevent in a proximal third tibial shaft fracture?
Apex anterior and valgus Chapter 37 - Page 482
What part of the limb bud is responsible for longitudinal growth?
Apical ectodermal Ridge (AER) Chapter 55 - Page 697
What is ataxia's impact on hip subluxation in CP patients?
Ataxia (hypotonia and tremors) is protective for hip subluxation Chapter 63 - Page 814
What is the most common symptom of patients with adult spinal deformity?
Back Pain 1. 77% in scoliosis patients compared to 35% general population 2. Therefore not all back pain can be attributed to scoliotic curve Chapter 45 - Page 585
In addition to relative risk, what other risk percentage should be presented to patients in order for them to make an informed decision about treatment?
Baseline risk. A relative risk only reflects the effect of an intervention relative to the control group, but the baseline risk allows the patient and the provider to interpret that value. For example, a 50% risk reduction may seem large, but if the baseline risk is only 0.5% to begin with, then a change from 0.5% to 0.25% may not be significant. Chapter 15 - Page 168
Why is there a recommendation to do a close reduction and percutaneous pinning of Type II supracondylar humerus fractures which were treated with close reduction and casting in the past?
Because of loss of reduction and malunion (Study of CR Cast: One third lost reduction, 17% reoperation) Chapter 53 - Page 678
What is a "double clavicle" in a growing child?
Because of the strong periosteal sleeve not displacing with distal clavicle fractures, when healing with what appears to be 2 clavicles in a bayonet opposition Chapter 53 - Page 676
When should you do a reduction of a cervical spine fracture dislocation in an awake and alert patient? Before or after an MRI?
Before 1. Prospective studies have found that in an awake and examinable patient with spinal cord injury a closed reduction with traction with avoidance of neck manipulation can be done safely prior to obtaining an MRI 2. In an awake and neurologically intact patient, closed reduction can be done first if an MRI is not readily available 3. Balanced between risk of delay in reduction, further injury in transfer to and positioning in MRI suite versus additional information afforded by MRI Chapter 48 - Page 627
If necessary to diagnose compartment syndrome in association with a tibial shaft fracture, when should intracompartmental pressures be performed?
Before induction of general anesthesia due to possibility of a spuriously low diastolic blood pressure Chapter 37 - Page 479
Which test is used to test the upper subscapularis strength?
Belly press test Patient places hands on abdomen and must maintain elbows anterior to midsagittal plane of body. A.: Normal; B.: Weakness upper subscapularis Chapter 24 - Page 305
With retracted subscapularis tears, what frequent MRI finding is seen in regard to the biceps tendon?
Biceps tendon will not be in bicipetal groove on coronal MRI with subscapularis tear Chapter 24 - Page 304
What bony structure separates the ACL bundles?
Bifurcate ridge Chapter 35 - Page 453
What is the most common foot deformity with CMT?
Bilateral cavovarus foot deformity 80 percent of cavovarus feet have CMT disorder Cavovarus foot of Charcot-Marie-Tooth Chapter 63 - Page 820
What questions should be considered by physicians when using clinical practice guidelines?
Clinicians should evaluate the validity and content of the guideline recommendations and their applicability to the patient in question Chapter 14 - Page 161
The Pipkin classification is used for femoral head fractures. Pipkin-type I does not involve the weight-bearing portion of the femoral head therefore can be treated how?
Close reduction If concentric reduction, no ORIF Chapter 31 - Page 401
What are the vertebral end plates?
Cartilaginous structures that form the superior and inferior boundaries of the intervertebral disk Chapter 3 - Page 28
What results from the chronic lack of glucose in the center of the disc?
Cell death Chapter 3 - Page 30
What is the most common inherited hereditary motor sensory neuropathy?
Charcot-Marie-Tooth disease Chapter 63 - Page 819
Name the type of study that selects a group of patients who have undergone a particular exposure or treatment and compares them to another similar group of patients who did not have the same exposure or treatment. If done prospectively, what level of evidence is this?
Cohort study A prospective cohort study is Level I evidence. 1. The 2 groups are matched for known prognostic variables (age, sex and medical comorbidities) 2. There is no randomization therefore unknown prognostic and compounding variables may not be matched. 3. Therefore requires: a. Strict inclusion and exclusion criteria b. Data analysis c. High follow up rates Chapter 15 - Page 170
What is the most common type of radial longitudinal deficiency?
Complete absence of radius Chapter 55 - Page 698
What MRI study is pathognomonic for infection postoperatively?
Enhancement of a fluid collection with gadolinium Chapter 43 - Page 571
What configuration of K-wires should be avoided which might impair stability in fixation for Salter-Harris I and SH II fractures?
Crossing at the fracture site Chapter 59 - Page 754
Name the type of randomized control trial in which two groups each receive both interventions at different time periods. Also, name a limitation of this design.
Crossover design Limitation is that this cannot be done for surgical interventions that can only be performed once i.e. it would be inappropriate for the patient to receive a plate fixation after already receiving intramedullary fixation. Chapter 15 - Page 169
What gait pattern can occur with tight hamstrings and a flexion contracture of the knee in CP patients?
Crouched gait pattern which can result in increased effort to walk and patellofemoral (increased load) symptoms Excessive stance-phase flexion and increased energy demand on CP patient Chapter 63 - Page 814
What is the thought process behind allowing permissive elevation of mean arterial pressure (MAP) in spinal cord injury patients?
Elevated MAP increase his spinal cord perfusion- ongoing ischemia may worsen secondary damage (Optimal MAP post injury is unknown) Chapter 44 - Page 576
What common sport often leads to these mid-foot injuries?
Equestrian sports Chapter 59 - Page 759
What does the "D" stand for in the initial screening in the new "ABCD" of the Advanced Trauma, Life Support Protocol (ATLS)?
Disability-quick assessment if patient can move all 4 extremities Potential cervical spine injuries always must be considered with trauma patients while maintaining the airway. Chapter 44 - Page 573
Whereas muscular dystrophy is a disorder of the dystrophin protein in muscle, what is the pathology of spinal muscular atrophy
Degeneration of anterior horn cells in the spinal cord Chapter 63 - Page 819
What is the third most common study type in orthopaedic literature?
Diagnostic study Chapter 14 - Page 159
Each spinal nerve consists of a ventral and dorsal root. Which is root is efferent and which is afferent?
Dorsal = afferent (sensory input) Dorsal root ganglion: Cell bodies of afferent nerves Ventral =efferent (motor neurons) Chapter 19 - Page 226
The infection rate for lumbar microdiscectomy is 0.7%. The use of a microscope does what to the infection rate?
Doubles the infection rate Chapter 43 - Page 570
In the evaluation of a postoperative infection the ESR is less helpful than a CRP. How do ESR and CRP change in response to surgery (in this case the initial surgery)?
ESR remains elevated up to 6 weeks after surgery CRP remains elevated up to 2 weeks Chapter 43 - Page 571
What is the initial treatment of primary shoulder dislocation for high risk athletes?
Early surgery may reduce the risk of dislocation (controversial) Chapter 61 - Page 788
How do you test for infraspinatus weakness? Chapter 24 - Shoulder Instability and Rotator Cuff Disorders
Ext rotation lag-Adduct arm, externally rotate patient can not hold Chapter 24 - Page 305
Describe the clinical (constitutional signs) and laboratory findings of a patient with nonpyogenic vertebral osteomyelitis.
Fever may or may not be present, chronic illness and malnourishment, coexisting immunocompromised state (in many cases), elevated ESR and CRP, often normal WBC Chapter 43 - Page 568
What is the primary restraint to knee varus stress?
Fibular collateral ligament Chapter 35 - Page 455
Which metatarsal is more likely to be injured in an older child during athletic events?
Fifth metatarsal Chapter 59 - Page 759
For metastatic lesions and round cell sarcomas which needle biopsy is more accurate, fine needle aspiration or core needle biopsy?
Fine-needle aspiration Chapter 8 - Page 102
Which metatarsal is most likely to be injured in a child less than 5 years old?
First Metatarsal from a fall from height Chapter 59 - Page 759
What is the appropriate treatment for femur shaft fractures in patients greater than 11 years and under 100 pounds with length stable fracture?
Flexible nail Flexible nail or midshaft femur fracture, length stable Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 732 Chapter 57 - Page 731
Range of motion is first lost in what direction in hip OA?
Flexion and internal rotation Chapter 32 - Page 413
What is the anterior impingement test for FAI?
Flexion to 90° and maximum internal rotation and adduction elicits symptoms Anterior impingement test-flexion to 90, maximum internal rotation and adduction NB: Post-SCFE hips have limited internal rotation Femoroacetabular Impingement Javad Parvizi, J Am Acad Orthop Surg September 2007 ;15:561-570. Chapter 32 - Page 414
What is the method of action of Fondaparinux?
Fondaparinux is an inhibitor of factor Xa. Chapter 12 - Page 138
How are focal articular cartilage defects treated?
For younger (<50) think surgical (microfracture, ACI, OATS) For older than 50, think arthroplasty Chapter 35 - Page 460
What mechanism results in talar neck fractures in children?
Forced dorsiflexion Chapter 59 - Page 758
Adult acquired flatfoot results in what deformity of the forefoot and hindfoot?
Forefoot abduction Hindfoot valgus Chapter 40 - Page 527
What is the most common inherited ataxia (spinocerebellar degenerative disorder)?
Friedreich's Ataxia Chapter 63 - Page 820
There is Level I evidence that botulinum toxin works in what muscle group to control specificity?
Gastrocnemius-soleus complex (tight heel cord) (botulinum toxin can be used to delay surgery until the age of decreased recurrence) Chapter 63 - Page 812
What is the relationship of the soleus and gastrocnemius muscles and their aponeurosis?
Gastrocnemius: Muscle is posterior to it' s aponeurosis Soleus: Muscle is anterior to it's aponeurosis Gastrocnemius muscle posterior to aponeurosis and soleus muscle anterior to aponeurosis. Chapter 63 - Page 815
What is the genetic defect with Duchenne muscular dystrophy?
Gene defect of the dystrophin protein (Xp21) Causes failure of muscle fiber regeneration Dystrophin cytoplasmic rod shaped protein connects the cytoskeleton of a muscle fiber to the surrounding cytoplasm through the cell membrane Chapter 63 - Page 818
What deformity often occurs after proximal tibial metaphyseal fracture (Cozen Fracture)?
Genu Valgum-overgrowth of the medial physis (Peaks around one year after injury, usually resolving spontaneously. If not hemiepiphysiodesis) Chapter 59 - Page 756
Which muscle tendon unit is injured with an apophyseal avulsion of the iliac crest?
Gluteus medius Chapter 61 - Page 788
What are the main drawbacks of an exoskeletal prosthesis?
Heavier and difficult to make changes to the alignment after prosthesis has been manufactured ( Most current prostheses are endoskeletal) Chapter 41 - Page 544
Equinovalgus deformity is more common in what type of cerebral palsy?
Hemiplegic cerebral palsy Chapter 63 - Page 815
Why is the Goutallier CT scan grading system important?
Higher degrees of rotator cuff muscle fatty infiltration (>grade 3) are associated with recurrent tears. Grade 3 means the fat infiltration equals the muscle mass. Goutallier Classification of Fatty Infiltrationa Grade Finding 0 No fat within the muscle 1 Some fatty streaks 2 Fat < muscle 3 Fat = muscle 4 Fat > muscle Fatty infiltration of the rotator cuff muscles was first based on CT, but is now more commonly evaluated on MRI studies. Fatty infiltration greater than grade 2 is associated with a higher rate of failure. (Reproduced with permission from Goutallier D, Postel JM, Bernageau J, Lavau L,Voisin MC. Fatty muscle infiltration in cuff ruptures: Pre- and postoperative Chapter 24 - Page 304
What effect does fixing the fibula have on union rates when nailing a tibial shaft fracture?
Higher nonunion rates Chapter 37 - Page 483
What is the region of the neuron cell body where the axon originates from?
Hillock (action potential is produced) Chapter 19 - Page 225
What proximal muscles compensate for weak ankle plantar flexors during initiation of swing phase in Charcot-Marie-Tooth?
Hip flexors (which when fatigued, trunk flexors increase) Strengthening of proximal muscles at hips and trunk-> improved stamina Chapter 63 - Page 820
What is the concern if the hip abduction is limited?
Hip subluxation X-ray should be obtained. (Hip adductor and flexors with increased tone overpower hip abductors and extensors-> subluxation and dislocation) Chapter 63 - Page 814 11 year-old with cerebral palsy and subluxation of the left hip
How long should prophylactic antibiotics be continued after closure of grade I-III wounds?
I-II: 24 hours after closure of wound and last debridement III: 72 hours Chapter 5 - Page 50
Which antibiotic choices are appropriate for each grade of open fractures?
I: First or second generation cephalosporin II: First or second generation cephalosporin III: Need better gram negative coverage, first or second generation cephalosporin and an aminoglycoside Chapter 5 - Page 50
How does arthroscopic versus open synovectomy compare in patients with intact architecture but active synovitis (Larsen I)?
If preoperative arc of flexion is less than 90°, both open and arthroscopic produced equal benefits. In patients with arc of flexion less than 90°, arthroscopic synovectomy provided better function results. Chapter 27 - Page 343
After closed reduction of supracondylar fracture, if pulse is lost, how is the patient managed?
If the pulse returns after closed reduction, the patient is admitted for observation. If the pulse does not return, but there is a Doppler signal at the wrist and the hand remains well perfulsed, the recommendation is to admit the patient and carefully monitor perfusion and active finger motion over the next 48 hours. Chapter 53 - Page 679
Which muscle tendon unit is injured with an apophyseal avulsion of the lesser trochanter?
Iliopsoas Chapter 61 - Page 788
When is the PCL posteromedial bundle taut?
In extension Chapter 35 - Page 456
When is the anterolateral bundle of the PCL taut?
In flexion Chapter 35 - Page 456
Where is the extent of soft tissue injury best examined and determined?
In the operating room Chapter 5 - Page 49
How long should intravenous antibiotics be used in treating open fractures during the initial treatment and subsequent debridements?
Initial debridement: 24-72 hours Subsequent debridement: 24 hours Chapter 37 - Page 484
What exam is specifically positive with recurrent posterior shoulder instability?
Jerk test: A.Posterior forces applied along the axis of the humerus with the shoulder forward flexed, abducted 90° and the elbow flexed at 90°causing the humeral head to subluxate posteriorly.B.As the arm Is brought into extension a clunk will be felt as the humerus reduces in the glenoid J Am Acad Orthop SurgAugust 2006vol. 14 no. 8 464-476
The ACL posterolateral bundle is taut in?
Knee extension Chapter 35 - Page 453
The ACL anteromedial bundle is taut in?
Knee flexion Chapter 35 - Page 453
There is a high rate of avascular necrosis and femoral head fractures surgery using what approach?
Kocker-Langenbeck Chapter 31 - Page 402
Patients with mild to moderate dysplasia of the hip report a knifelike pain in the groin and a sensation of catching or locking due to what?
Labral tear Chapter 32 - Page 417
Asymptomatic adolescence with dysplasia necessitates close follow-up. In patients with diminished head coverage (as per CE and VCA angles), early osteoarthritis can develop. A tear of what structure increases the risk of early osteoarthritis?
Labral tear Chapter 58 - Page 744
Meniscal tears are less common in children as compared to adults. Pediatric meniscal tears are usually associated with a tear of the ACL or other significant knee injuries. MRI evaluation for meniscal tears in children are more or less accurate compared to adults?
Less accurate What appears to be a meniscal tear on MRI in a child, frequently will have a normal arthroscopic evaluation given meniscal signal variation in children Chapter 61 - Page 785
Is aspirin effective for reduction of VTE for patients undergoing TKA?
Less effective method when used alone. However, a study that compared the use of SCDs combined with ASA vs. LMWH alone found there was no difference in the DVT rate (ultrasound was used) therefore this combination therapy may be as effective as and perhaps safer than LMWH Chapter 12 - Page 138
What is the risk of HIV transmission from allogenic blood transfusion?
Less than 1 per 1 million Chapter 12 - Page 143
What is the physical findings of valgus extension overload?
Limited extension and or internal derangement secondary to loose bodies 1. Wind-up 2. Early Cocking 3. Late Cocking 1. Anterior Glenohumeral Instability 2. RTC 3. SLAP Tear 4. Quadrilateral Space Syndrome 5. Medial Elbow Instability 6. Capitellar OCD 4. Acceleration 1. Internal Impingement 2. Rotator Cuff Tear (RTC) 3. Scapulothoracic bursitis 4. Medial Elbow instability 5. Olecranon apophysitis / stress fx 6. Valgus extension overload 5. Deceleration 1. RTC 2. SLAP Tear 3. Subacromial Impingement 4. Posteromedial Elbow Impingement 6. Follow-through 1. Olecranon apophysitis 2. Olecranon Stress Fracture Chapter 61 - Page 790
Stiffness, also known as the modulus of elasticity (E modulus) is represented by what portion of the stress-strain curve and represents what ratio?
Linear portion of the stress/strain curve The ratio of applied load to the resulting compression of the cube (E modulus =stress/strain) Chapter 6 - Page 59
Surgical approach to an epidural abscess is dependent on what?
Location (if anterior location, cannot decompress with a posterior laminectomy) Chapter 43 - Page 570
What is the best treatment for lytic lesions or pathologic fractures of the intertrochanteric or subtrochanteric femur?
Long Cephalomedullary nail (Possibility of skip lesions) Chapter 31 - Page 406
Fractures in what age group should prompt a skeletal survey and consultation with child protective services?
Long bone fractures in non-ambulatory children (less than 2 years) Chapter 59 - Page 753
What is the primary restraint to lateral patella subluxation at 20° knee flexion?
MPFL (medial patellofemoral ligament) Chapter 35 - Page 460
What is the F-wave study?
Measures the nerve conductance velocity of the proximal nerve including anterior horn cell body and radiculopathy Supramaximal stimulating impulse with action potential travels from limb to the spinal cord central horn and back to the limb on the same nerve. The F-wave latency can be measured a =F-wave study, b = H-reflex study Chapter 19 - Page 229
Because of the mobility or lack of it, how are the medial column and lateral column of the foot reconstructed differently for arthritis?
Medial column (minimum mobility): Typically arthrodesis Lateral column (more mobile): Typically arthroplasty Chapter 40 - Page 523
What type of meniscus tear is common in the chronic ACL injured knee?
Medial meniscus Chapter 35 - Page 453
What is the most common neurologic finding of Lyme disease? What is the less common presentation which may resemble Guillain-Barré syndrome?
Most common: Facial neuropathy (bilateral in 50%) which occurs in stages 2 and 3 (differential of Bell's Palsy) Polyradiculoneuropathy (may resemble Guillain-Barré) 50% have numbness, paresthesias, weakness and cramps in the distal extremity with reduced proprioception and vibration Facial palsy similar to Bell's palsy from Lyme disease Chapter 19 - Page 234
What is the most reliable test that can be used to aid in determining level of amputation?
Most reliable test-TcO2 (transcutaneous Oxygen pressure) 1. Partial pressure of oxygen diffusing through skin Chapter 41 - Page 538
Who is the carrier of the X-linked recessive gene in muscular dystrophy - father or mother?
Mother Mother is typically the carrier in excellent recessive Chapter 63 - Page 818
What type of shoulder instability is defined by instability in more than 1 plane?
Multidirectional instability (MDI) Chapter 24 - Page 303
In using the Modified Schenck classification for Multiligamentous knee injury, the KD-V indicates which ligaments are injured?
Multiligamentous injury with periarticular fracture Chapter 35 - Page 458
Cerebral palsy patients are classified by the muscle tone abnormality and part(s) of the brain are damaged. Give four muscle tone classifications.
Muscle tone classifications 1. Spastic-increased muscle tone (cerebral cortex) 2. Ataxic-hypotonic and tremors associated with problems of coordination (cerebellum) 3. Athetoid or Dyskinetic-hypertrophy and hypotropia associated with abnormal movements (basal cell ganglia) 4. Mixed Basal ganglia( 2 shades of purple structure):group of nuclei work together as a switch for voluntary motor control (release of inhbitory control), learning with routine habits and behaviors. A report: The definition and classification of cerebral palsy April 2006". Developmental Medicine & Child Neurology 49: 8-14. 2007. doi:10.1111/j.1469-8749.2007.tb12610.x. Chapter 63 - Page 812
What is the most common cause of granulomatous vertebral osteomyelitis (nonpyogenic osteomyelitis of the spine)?
Mycobacterium. tuberculosis (aka: Potts disease) Chapter 43 - Page 567
What is the usual neurologic deficit with unilateral fracture dislocations?
Nerve root injury on side of dislocation Chapter 48 - Pages 633-634
Do posterior dislocations tend to recur?
No Chapter 24 - Pages 302-303
Is running associated with increased risk of osteoarthritis?
No Chapter 3 - Page 24
Is there any difference in the functional outcome after 10 years with 4 strand hamstring versus patellar tendon autografts?
No Chapter 35 - Page 454
Does the literature clearly indicate the need for surgical intervention for first time traumatic dislocation of the patella?
No Chapter 35 - Page 461
Does epidural steroids for low back pain in adult scoliosis patients give sustained relief?
No Chapter 45 - Page 587
Is there any evidence in the literature that surgical correcting the coronal imbalance in adult scoliosis will improve outcomes?
No Chapter 45 - Page 588
Is there clear evidence that electromyographic monitoring during pedicle screw placement help in preventing nerve root injury during scoliosis surgery?
No Chapter 45 - Page 592
Are dynamic locking plates indicated for trauma cases for anterior plating?
No Chapter 48 - Page 632
Is surgical excision of the synostosis in radioulnar synostosis usually successful in gaining range of motion?
No Chapter 55 - Page 706
Does bracing and casting help Legg-Calve-Perthes disease?
No Chapter 58 - Page 746
Are there consistent improvements with double bundle versus single bundle reconstruction?
No Chapter 35 - Page 454
The loss of the coronal plane force couple results in superior head migration. Does this always lead to loss of function?
No Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 301 Chapter 24 - Page 299
What is the Silvferskiold test and it's importance?
Normal ankle dorsiflexion: 1. With knee extension (and hindfoot locked in varus), normally there is 10° of dorsiflexion. 2. With the knee flexed at 90° there is an additional 10° of dorsiflexion (20° of total dorsiflexion) Isolated gastrocnemius contracture as seen in cerebral palsy: 1. Equinus contracture with the knee extended (20° of plantarflexion) 2. With the knee flexed to 90°, ankle dorsiflexion improves significantly (10° of dorsiflexion) Combined gastrocnemius and soleus contracture or isolated soleus contracture 1. Equinus contracture with knee extended 2. Equinus contracture unchanged with knee flexion Chapter 63 - Page 815
What is finite element analysis?
Numerical method to compare stress, strain and deformation with a digital structure Finite element analysis of a cephalo-medullary fixation of a subtrochanteric femur fracture Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 70 Chapter 6 - Page 69
What is the acceptable treatment for hip dislocation with posterior wall fragment greater than 50% of the wall?
ORIF Chapter 31 - Page 401
What is the treatment indicated for Types III lateral humeral condyle fracture?
ORIF Fluoroscopic images showing proper placement of 3 pins engaged in 6 cortices Chapter 53 - Page 680
The only FDA approval for rBMP-2 for tibial shaft fractures is in what scenario?
Open fractures treated within 2 weeks Chapter 37 - Page 485
What is the suspected etiology of developmental coxa vara?
Ossification defect in the inferior femoral neck with fatigue fracture (bilateral in 33-50%) Chapter 58 - Page 744
What should be used to trigger a blood transfusion in orthopaedic surgery patients?
Patient specific risk factors and not "automatic" trigger points should be used to determine when a blood transfusion is needed. Chapter 12 - Page 141
Which is a more common fracture in pediatric pelvic injuries, pelvic ring or acetabular?
Pelvic ring 87% (Acetabular 13%) Chapter 57 - Page 727
What prophylactic antibiotic should be added for open fractures contaminated with soil or has severe ischemia?
Penicillin Chapter 5 - Page 50
Analyzing the patients as per which treatment they received is what type of analysis? Important with trials where patients switch from one treatment protocol to another.
Per-protocol analysis May not maintain prognostic balance or randomization Chapter 15 - Page 175
What is the non arthroplasty surgical treatment for hip dysplasia?
Periacetabular osteotomy (PAO) Chapter 32 - Page 418
Under conditions of high energy transfer, which part of a pediatric joint fails first?
Physeal cartilage is more susceptible to injury and will fail before other areas including ligament and bone Chapter 61 - Page 784
Patients with scoliosis may stand erect but with ambulation and fatigue may cause what type of imbalance?
Positive sagittal imbalance (i.e. Pitched forward) A. Normal sagittal balance B. Abnormal sagittal balance (pitched forward) Chapter 45 - Page 585
Name a potential pitfall of performing post hoc subgroup analyses. How can this be avoided?
Post hoc analyses could potentially find a statistically significant result (spurious false-positive) by chance alone as a result of data mining. To avoid this problem, subgroups should be identified prior to data collection. Chapter 15 - Page 172
What is the Posterioinferior (Posterior) impingement test for FAI?
Posterioinferior impingement test-extension of the hip with external rotation elicits pain Posterior or Posterioinferior impingement sign Femoroacetabular Impingement Javad Parvizi, J Am Acad Orthop Surg September 2007 ;15:561-570. Chapter 32 - Page 414
When a pediatric patient suffers a hip dislocation, which direction does it most commonly occur?
Posterior Chapter 57 - Page 727
What is the less common instability with applied internal rotation (pronation) and varus force?
Posterior medial rotatory instability Chapter 27 - Page 346
What is the second most common type of study in orthopaedic literature?
Prognostic study Chapter 14 - Page 159
Clinodactyly is a autosomal dominant trait that can lead to what type of progressive deformity of the digits?
Radial ulnar deformity Chapter 55 - Page 705
What is sourcil?
Radio-dense subchondral bone of the weight-bearing dome of the acetabulum Pincer type of FAI involving sourcil (radiodense subchondral bone) Reprinted with permission from Flynn, JM (ed), Orthopaedic Knowledge Update 10, Rosemont, IL American Academy of Orthopaedic Surgeons, 2011, Page 415 Chapter 32 - Page 415
In fixed sagittal imbalance syndrome, what is the definition of 6 sagittal imbalance?
Radiographic sagittal imbalance of more than 5 cm Chapter 45 - Page 589
With intact cartilage, what approach should be used with micro-drilling of a small lesion?
Retrograde drilling to prevent chondral injury Chapter 40 - Page 526
What is the most important predictor of outcome of surgical correction of adult scoliosis?
Sagittal balance Chapter 45 - Page 588
What is the definition of Adult Idiopathic Scoliosis?
Scoliosis in a skeletally mature patient that existed in childhood or adolescence Chapter 45 - Page 587
What is the frequency of scoliosis with Friedreich's ataxia?
Scoliosis occurs in at least 60% of patients Chapter 63 - Page 820
How long do typical radiographic changes take to develop in infection?
Several weeks Chapter 43 - Page 566
With the use of external fixation in pediatric femur fractures, the delayed union and refracture rate are more common compared to rigid internal fixation (1.5-21%). What fracture patterns has an increased risk of delayed union and refracture?
Short oblique fracture (With the use of rigid external fixator, secondary calluses less likely to form) Oblique fracture defined as length less than 2 bone diameters Spiral fracture the fine as length greater than 2 bone diameters Chapter 57 - Page 734
What are the usual symptoms of little leaguer's shoulder?
Shoulder and proximal arm vague pain aggravated by throwing and improved with rest Chapter 61 - Page 789
Open surgery for recurrent posterior shoulder dislocation has been successful 85% of the patients with 5-7 year follow-up. What had been the arthroscopic results?
Similar results but with shorter follow-ups Chapter 24 - Page 303
In neonatal compartment syndrome, what is always accompanied on the affected limb?
Skin lesion Chapter 55 - Page 711
The Vulpius procedure is a intramuscular fascial release of what muscle?
Soleus muscle maintaining soleus muscle strength Cadaver showing soleus and gastrocnemius with their aponeurosis Chapter 63 - Page 815
How has stability tested post reduction of radial neck fractures determined if fixation is indicated?
Stability is tested under fluoroscopy after reduction supinating and pronating the arm Chapter 53 - Pages 682
What are three stages of outlet impingement?
Stage I Reversible edema ....Treat conservative Stage II Irreversible fibrosis... Treat conservative, surgery Stage III Rotator cuff tear..... Subacromial decompression, rotator cuff repair Chapter 24 - Pages 303-304
What are four stages of osteochondral lesions of the talus?
Stage I: Intact cartilage with a bone injury Stage II: Nondisplaced cartilage injury, incomplete Stage III: Nondisplaced cartilage injury, complete Stage IV: Detached OCL Chapter 40 - Page 526
Test loads can be done statically or dynamically. Which typically is used early to test stiffness, constraints, load transfer and strength assessment?
Static Loading Chapter 6 - Page 67
What are the structures at risk with anterolateral submuscular plating technique for the tibia?
Superficial peroneal nerve distally Chapter 37 - Page 481
In which zone is posttraumatic chondrocyte death associated with osteoarthritis?
Superficial zone Leads to permanent matrix damage Preventing post traumatic cell death would prevent OA Chapter 3 - Pages 25-26
Which MRI views best shows acute ligamentous injury?
T2-weighted fat-suppressed MRI T2-weighted fat-suppressed of DISH patient. Note edema anterior to C2-C3 interspinous ligaments. Arrow indicates OPLL C6-C7 Chapter 48 - Page 624
What muscle weakness does the drop arm test examine?
Supraspinatus Passively abduct the shoulder to 90 degrees, flex to 30 degrees and point thumbs down. The test is positive if the patient is unable to keep arms elevated after the examiner releases Chapter 24 - Page 304
Which perforator type flap allows adequate coverage of the distal third tibia?
Sural flap Chapter 5 - Page 53
If the femoral neck stress fracture is completely across the femoral neck or is at the superior neck (tension side) What treatment is recommended for these types femoral neck stress fractures?
Surgical Stabilization Chapter 31 - Page 404
How is nutrition to the intervertebral disk achieved?
The intervertebral disk is largely avascular. There are only meager capillary endings along the superficial perimeter of the anulus fibrosus (minor contributor). The rest of the disk acquires its nutritional supply through diffusion across the endplates (majority of nutritional supply). Diffusion of nutrients from peripheral annulus fibrosis and end plate Chapter 3 - Pages 29-30
In thrower's elbow lateral overload type, the capitellum and rarely the radial head are at risk for what?
The lateral side is subject to compressive loads resulting in OCD of the capitellum and rarely radial head. OCD capitellum Chapter 61- Page 790
What is the yield strength of a material?
The load at which permanent plastic deformation begins to occur (plastic region = lack of reversal of deformation after force removed) Chapter 6 - Page 60
What is the ultimate strength of a material?
The load at which the material fractures Chapter 6 - Page 61
What phalanx and what finger is most commonly affected in clinodactyly?
The middle phalanx of the small finger (bending towards the ring finger) Chapter 55 - Page 705
What determines the spinal cord neurologic level?
The most caudal level with normal function for motor The most caudal level with normal sensation. Sensory dermatomes Chapter 44 - Page 574
Can adult onset neurologic conditions such as multiple sclerosis and Parkinson's disease result in neuromuscular adult scoliosis?
Yes Chapter 45 - Page 592
What is the advantage of knowing the ABI is > 0.9 with a knee dislocation?
The negative predictive value for a vascular injury is 100% (patient did not damage artery) Chapter 35 - 458
What complication occurs if radial neck fractures heal in > 30 degrees of angulation or > 5 mm of translation?
The normal rotational arc of the radius around the ulna becomes disrupted by a cam effect, limiting pronation and supination of the forearm. Chapter 53 - Page 682
Describe the Importance of timing of the first prosthesis.
The sooner the patient receives the 1st prosthesis, the better the outcome Chapter 41 - Page 543
What is the insertion point of the anterior bundle of the MCL (important aspect of anteromedial facet injuries)?
The sublime tubercle Avulsion fracture of the sublime tubercle (demonstrating tubercle but not fracture pattern of posterior medial rotatory instability) Chapter 27- Page 346
What is the target INR when Warfarin is used for prophylaxis in patients undergoing hip fracture surgery?
The target INR for hip fracture patients is 2.5 with the same acceptable range of 2.0-3.0. (The AACP, American College of Chest Physician Guidelines state there is level 1B evidence to support this). Chapter 12 - Page 138
In a nondisplaced Salter-Harris I or II of the distal fibula associated with a distal tibia fracture, what determines treatment?
The tibia fracture Chapter 59 - Page 758
What is "toughness?"
The total energy needed for a construct to fail Represented numerically by the area under the stress strain curve Chapter 6 - Page 61
What factors influence the poor interrater reliability in assigning levels of evidence?
The training and experience of the raters who are submitting level of evidence grade Chapter 14 - Page 160
What is the most common study type in orthopaedic literature?
Therapeutic study Chapter 14 - Page 159
What is the alternate hypothesis?
There is a difference between the 2 groups studied Chapter 15 - Page 172
How many degrees of correction can be expected with the pedicle subtraction osteotomy in the thoracic and lumbar spine?
Thoracic spine: 25° Lumbar spine: 30-35° Chapter 45 - Page 590
What is the most important factor in treating open tibial shaft fractures?
Thorough timely debridement (start with skin debridement and work sequentially to bone) Chapter 37 - Page 484
What is the optimal number of pins for fixing a type III SCH fractures?
Three (2 lateral and 1 medial) Chapter 53 - Page 679
Redressing the wound in the emergency department causes an increase in what?
Three to four fold increase in the infection rate Chapter 5 - Page 49
What test is accurate to rule out osteomyelitis (no previous hardware or fracture) if the routine X-rays are negative?
Three-phase bone scan with focal increased flow and increased uptake of tracer on the delayed bone scan is greater than 90% sensitive and specific for osteomyelitis (no previous hardware or fracture) Chapter 8 - Pages 99
Current terminology for amputation length is no longer based on above knee, below knee etc, but rather on what?
Through a specific bone 1.Transfemoral, transtibial, through-knee Chapter 41 - Pages 537-538
Which level has a worse Sickness Impact Profile-Transfemoral or Through-knee?
Through-knee Through-knee worse sickness impact Chapter 41 - Page 538
Which digit is most frequently involved with Congenital trigger digit?
Thumb Chapter 55 - Page 710
Classification of Radial longitudinal deficiency is based on the extent of the deficiency. What is the range?
Thumb hypoplasia to complete absence of radius Chapter 55 - Page 698
What is the most common bone involved in stress fractures in the lower extremity?
Tibia Tibial stress fracture in a child Chapter 61- Page 792
The anterior and posterior horns of the meniscus are attached to what?
Tibia Chapter 35 - Page 458
How many of the static primary stabilizers of the elbow must be injured before leading to elbow instability?
Traumatic injury to any single primary stabilizer may lead to elbow instability, with most injuries involving a spectrum of pathology. Chapter 27 - Page 345
What is a point estimate (aka, point estimate of the effect)?
Treatment effect of a main study outcome (Would be represented by relative risks, odds ratio or risk reduction) Chapter 15 - Page 173
What surgical intervention is indicated for adult acquired flatfoot stage III?
Triple arthrodesis Postop X-ray of triple arthrodesis Adult-acquired Flatfoot Deformity • Jonathan T. Deland J Am Acad Orthop Surg July 2008 ; 16:399-406.
What is Brown-Sequard Syndrome?
Unilateral spinal cord injury (i.e. knife injury) Motor function and proprioception on ipsilateral side with pain and temperature sensation affected contralaterally Chapter 44 - Page 575
In patients with slipped capital femoral epiphysis, what increases the risk of avascular necrosis?
Unstable hip (inability to bear weight) 22% average risk compared to 4% in stable slipped capital femoral epiphysis Chapter 58 - Page 746
In fixation of distal femoral metaphysis (proximal to growth plate) there is a risk of joint sepsis. How can this be avoided?
Use retrograde fixation method and bury the pins a. Wire introduced distal to proximal direction b. Wire crosses fracture and far cortex c. K wire advanced through skin where the end is bent over Chapter 59 - Page 753
How does IV gadolinium with MRI scans evaluate tumor necrosis?
Used to assess the extent of necrosis within a tumor Ovarian tumor with necrosis seen with intravenous gadolinium (necrotic area does not enhance) Chapter 8 - Pages 95-96
How does IV gadolinium with MRI scans differentiate neoplasm from a cyst? Which enhances?
Used to differentiate a neoplasm from a cyst, because the neoplasm enhances Chapter 8 - Pages 95-96
Is it safe to perform an open reduction of a posterior hip dislocation via an open approach?
Yes. There used to be concern that an approach from the opposite direction than the hip dislocation could further damage the blood supply to the femoral head and lead to a higher incidence of AVN. Is it now believed that that is not the case and it is safe to perform an anterior approach to a hip that had been posteriorly dislocated if that is what is needed for definitive treatment. Chapter 31 - Page 400
Duplication of what part of the embryonic limb is thought to lead to dimelia?
Z.PA (zone of polarizing activity) Chapter 55 - Page 708
