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164 Cards in this Set
- Front
- Back
- 3rd side (hint)
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A 16 year-old dancer has developed popping over the anterior hip. On exam, this can be reproduced by starting with the hip flexed, abducted and external rotated, and then slowly extending it back to a neutral position. She has no pain with internal rotation of the flexed hip. There is no tenderness or popping laterally. -Dx/AKA? -The diagnosis can be confirmed using which imaging modality? -Stx? |
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A positive Ober test for contracture of the tensor fascia lata and iliotibial band is characterized by what PE finding??
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iliotibial band which limits adduction of the hip while in an extended position.
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iliopsoas tendon sliding over
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Physical exam
dx? -confirmation of Dx? -Stx? |
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loss of flexibility in the groin region, a dull aching pain in the groin, or in more severe cases a sharp stabbing pain when running, kicking, or changing directions.~ loss of flexibility in the groin region, a dull aching pain in the groin, or in more severe cases a sharp stabbing pain when running, kicking, or changing directions.
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early -MRI
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dx?
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pelvic osteochondroma.
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dx?
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stress fracture of the left inferior pubic ramus.
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Dx?
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compression-type femoral neck stress fracture on the right.
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dx?
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pubic symphisis diastasis with no underlying bony abnormalities.
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structure continuous with transverse acetabular ligament c/o
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-Innervation branch of nerve to the quadratus femoris & obturator nerve -anterosuperior labrum most common location -MRI arthrogram -arthroscopic labral debridement vs repair |
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Contra indications to hip arthroscopy? 5
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) The zona orbicularis is the arthroscopic landmark for access to which of the following structures? -clinical significance re tx? |
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MC complication when scoping hip?
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A 29-year-old male undergeoes hip arthroscopy using the three portals shown in Figure A. Postoperatively he develops numbness in the distribution shown in yellow. This complication was most likely caused by : -what nerve injury? -which portal? -MC neuroprxia with anterolateral portal? |
- portal A Lateral Femoral Cutaneous Nerve (LFCN). -placement of the anterior portal (Portal A in Figure).
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Transient nerve injury affecting the groin is usually due to traction against the perineal post used to distract the hip, which nerve?
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(pudendal nerve)
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hip scope, An anterior portal that is too far medial risks injury to the____nerve.
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- femoral N
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hip scope, Transient nerve injury affecting the dorsum of the foot are usually due to traction used to distract the hip, which nerve?
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-(peroneal N
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During hip arthroscopy, the sciatic nerve is most at risk with which of the following portal techniques? portal & limb position
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Posterior lateral portal with hip in external rotation
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) Complications from hip arthroscopy are most commonly related to ?
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traction injuries, iatrogenic chondral injuries, and neurovascular injury due to aberrant portal placement
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MC site of hamstring injury? -adult? -pedi? -Moi? |
myotendinous junction -avulsion of ischial tuberosity - result of hip flexion and knee extension |
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___ cell plays a role in muscle healing following muscle injury
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satellite
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Concomitant flexion of the hip and extension of the knee is most likely to result in an injury to which structure? innervation, o & I
muscles of hamstrings |
Biceps Femoris, part of the hamstrings muscle group, two heads of origin the long head- tuberosity of the ischium, short head, arises from the lateral lip of the linea aspera, inserted into the lateral side of the head of the fibula, and by a small slip into the lateral condyle of the tibia
long head: tibial nerveshort head: common peroneal nerve -(semitendinosus, semimembranosus and biceps femoris |
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hamstring is composed of the ___,___,___and all three components originate at the ___. -innervation, blood supply? |
semimembranosus, semitendinosus, and biceps femoris -ischial tuberosity -innervated by sciatic (tibial) nerve but short head bicepts fem=common peroneal N
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A 15-year-old boy sustains the injury seen in Figure A while running the hurdles. The same mechanism in an adult athlete would most likely result in which of the following injuries? -indications for surgery? |
Hamstring myotendinous junction rupture -if the fragment is large enough to accommodate hardware and if displacement is greater than 2 cm. |
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Which of the following most accurately describes the primary role of satellite cells? |
To regenerate skeletal muscle after muscle injury
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: Sonic hedgehog surface protein is involved in ____?.
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limb bud generation.
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after hamstring injury, when can one return to play?
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A professional rugby player has acute groin pain after an awkward collision with an opponent. MRI shows a severe avulsion injury of his adductor muscle. Which of the following is an appropriate treatment to provide?
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Immediate rehabilitation consisting of increasing passive and active motion |
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describe MRI findings? -arrow 1 & 2 |
T2 pelvic MRI with a left sided adductor tear, evidenced by the increased fluid signal. Arrow 1 points to the tendon origin on the pubic rami, arrow 2 is pointing to the avulsed adductor tendon. |
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-Quadriceps Contusion
-immobilize in 120 degrees of knee flexion for 24 hours followed by therapy -Angiotensin II receptor blockade (e.g. Losartan)
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-Moi of medication? -name of medicine to tx this condition? -dx? |
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avulsion of anterior inferior iliac spine (AIIS)
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Rectus Femoris Strain
-sudden, forceful eccentric contraction of the muscle
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A teenage boy injured his hip while competing in a track meet. His radiograph is shown in Figure A. Which of the following muscles is most likely injured?
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Rectus femoris
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MC muscle avulsion? -iliac crest? -ASIS? -AIIS? -greater trochanter? -lesser trochanter? -ischial tuberosity? body of pubis & inferior pubic ramis? |
iliac crest avulsion: anterior abdominal wall musclesanterior superior iliac spine (ASIS) avulsion: tensor fascia lata and sartoriusanterior inferior iliac spine (AIIS) avulsion: straight head of rectus femorisgreater trochanter: hip rotator cufflesser trochanter: iliopsoasischial tuberosity avulsion: hamstring musclesbody and inferior ramus of pubic bone: thigh adductors and gracili
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risk factors for femoral shaft stress fracture? (3) -confirm dX? |
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fatigue
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insufficiency
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PE finding to confirm Femoral Shaft Stress Fractures?
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"female athlete triad" consist of ?
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A 20-year-old male marathoner has had left sided groin pain for the past 4 weeks. He has continued to maintain his routine running regimen despite the discomfort. MR images are shown What is the most appropriate next step in management?
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Percutaneous screw fixation
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non-weight bearing and activity restriction for femoral neck fx indications? location of fx?
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ORIF with percutaneous screw fixation for femoral neck fx indications? location of fx?
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tension side stress fractures (superior-lateral neck)
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A 24-year-old female marathon runner experiences gradual onset of right groin pain. Initially it was only painful during running, but now it is painful with walking. She has no mechanical symptoms and denies back or lower leg symptoms. On exam, she has pain when attempting a straight leg raise and with passive internal rotation of the hip. Pelvis and hip radiographs demonstrate normal acetabular version and normal femoral head-neck offset. What is the next most appropriate step in her care?
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MR imaging of the hip - concerning for a femoral neck stress fracture, |
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A 22 year-old college cross-country runner developed hip and groin pain that initially started while running, but is now painful when walking across campus. Radiographs show no evidence of a stress fracture, an alpha angle of 45 degrees, and a lateral center edge angle of 30 degrees. An MRI shows focal, intense marrow edema in the superior-lateral femoral neck. What is the most appropriate treatment?
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Operative treatment with percutaneous screw placement
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pt is < 6 months
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pt is 4 yo
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pt is 3 yo
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pt is 8 yo
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(H) pt is 10 yo
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(H) pt is 12 yo
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pt is 12 yo
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17 yo girl
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pt is 12 yo 80 lbs
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Which of the following techniques used to treat pediatric femur fractures has been associated with damage to the deep branch of the medial femoral circumflex artery? |
Piriformis entry intramedullary nails have been associated with damage to the deep branch of the medial femoral circumflex artery (MFCA) and a risk of avascular necrosis in children and adolescents. |
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An 11-year-old female sustains an open right femoral shaft fracture and closed left both-bone forearm fracture after being struck by a motor vehicle. She is 5'1'' and weighs 146 lbs. No neurovascular deficits are noted in any of her extremities. Which of the following is a contraindication to elastic intramedullary nail fixation of her femur fracture? |
s pediatric patient is obese and weighs 146 lbs, and would be at risk of increased complications including nonunion if she underwent elastic intramedullary nail fixation. |
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Which of the following patients would be the BEST candidate for submuscular bridge plating? |
10 year old with contraindications to flexible nailing, 120-lb boy with a long spiral, comminuted midshaft femur fracture |
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A 14-year-old boy sustains a femoral shaft fracture while waterskiing. He is treated with a piriformis fossa entry antegrade intramedullary nail. Six months post-operatively the patient complains of persistent groin pain. What is the most likely complication he has sustained? |
Osteonecrosis following antegrade nailing of the femur in pediatric and adolescent patiens has been described and is believed to be the result of iatrogenic injury to the lateral epiphyseal branches of the medial circumflex femoral artery |
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A 4-year-old boy sustains a midshaft femur fracture with less than 2 cm of shortening that was treated with immediate closed reduction and hip-spica casting. what is the most common requiring early surgical intervention in this age group? |
Early hip spica cast treatment is the current mainstay of treatment in diaphyseal femur fractures in children less than 5 years of age. Complications of this treatment method are relatively low, but those requiring early revision of treatment most commonly involve loss of reduction. |
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A 13-year-old male is involved in motor vehicle accident. He has a GCS of 6 and is intubated at the scene. He has a splenic laceration that will require an emergent exploratory laparotomy and he has a left hemothorax requiring a chest tube. His femur fracture is shown in Figure A. What is the next best step in management of this fracture? |
External fixation for this polytraumatized adolescent that is going to the operating room emergently for abdominal surgery is the most appropriate step, and can be thought of as damage control orthopaedics. |
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A 7-year-old boy sustains an isolated, closed injury shown in Figure A. He weighs 55lbs and is otherwise healthy. What is the best treatment option for this patient? |
transverse midshaft femur fractures in a skeletally immature patient. In this age bracketclosed reduction and flexible intramedullary nailing is the best treatment option. |
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An 11-year-old girl sustains the following injury seen in Figure A. Assuming she has complete physeal arrest, what is the expected limb-length-discrepancy? mn |
(23/15/9)/(6/5/3/16/14) & >2 yrs/>2 cm/<50=excision bar &> 20% osteotomy 23Leg/15knee/9DFem/6Ptib/5Dtib/3Pfem-16/14; skeletal maturity B=16 & G=14 therefore 14-11= 3 years x 9 = 27 mm or 3 cm |
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A 10-year-old female presents after being struck by a car while riding her bicycle. Her right leg shows significant swelling and deformity around the knee. An injury radiograph is shown in Figure A. Further radiographic work-up confirms the diagnosis of a Salter-Harris II fracture, without any other significant bony injury. The patient is treated definitively with open reduction and internal fixation with lag screws in the metaphysis. Mc complication? |
growth arrest. |
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An 11-year-old boy underwent surgical intervention for the injury shown in Figure A two years ago. He currently does not complain of knee pain, but the parents have noticed a progressive bow-leg deformity. Physical examination reveals 5 degrees of varus relative to contralateral side. Current radiographs are provided Figure B. Physeal mapping via CT demonstrates a bar involving 25% of the physis. The remainder of the physis is open. Which of the following is the most appropriate management? |
Physeal bridge excision is a recommmended treatment option for patients with a resulting deformity in which there is at least 2 years or 2 cm of growth remaining and a physeal bridge that is less than or equal to 50% of the physeal area. |
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current indication for osteotomy is correction of angular deformities____° because they likely will not correct spontaneously after bridge resection. |
>20 |
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which variable in not associated with an increased risk of complications with treatment of distal femoral epiphyseal fractures ? MC complication? |
direction of fracture displacment -Deformity (most common)results from physeal arrest and can produce limb length discrepancy and/or angular deformity |
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A 10-year-old boy presents to the emergency room after injuring his left knee while playing soccer. He localizes the pain to the distal femur, and is unable to bear weight on the affected leg. On physical exam the patient is tender to palpation only directly over the distal femoral physis. He has swelling about the distal thigh, without any signs of knee effusion. An AP and lateral radiograph of the affected knee are shown in Figures A and B. An AP and lateral radiograph of the contralateral knee are shown in Figures C and D.
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A 13-year-old boy is unable to bear weight after sustaining a twisting injury during football practice. Physical exam shows swelling and tenderness over the distal femur. Radiographs are shown in Figure A. What is the most appropriate treatment? MC complication? |
displaced Salter-Harris II fracture of the distal femoral physis. Because the fracture is displaced, closed reduction with percutaneous pinning would be the most appropriate treatment -Deformity (most common)results from physeal arrest and can produce limb length discrepancy and/or angular deformity |
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physeal bar of <50% and at least 2 years or 2 cm of growth remaining tx? |
physeal bridge excision |
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7 yrs old
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3 yo
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A 14-year-old male sustains the injuries shown in Figures A and B after a fall off the roof of his house.What is the most appropriate management? dx/classifation? |
transcervical (Delbet II) femoral neck fracture. Transphyseal cancellous screws are indicated for fixation of the femoral neck fracture in this case. |
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) What is the most common complication following surgical fixation for the fracture shown in Figure A in an 8-year-old boy? |
pediatric basicervical femoral neck fracture. Femoral neck fractures in the pediatric population are associated with a high rate of osteonecrosis |
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A 14-year-old boy develops an acutely swollen right knee playing volleyball. During the examination, he is unable to perform a straight leg raise due to pain. Figure A shows a lateral radiograph of his right knee. What would be the most appropriate management of this injury? dx/class? |
displaced tibial tuberosity fracture, and the treatment of choice would be open reduction and internal fixation. |
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A 15-year-old male complains of pain and swelling of the right knee immediately after landing a ski jump. Radiographs are shown in Figure A. Which of the following potential concomitant diagnosis should be particularly observed for with this injury pattern? dx/class? |
type III tibial tubercle avulsion fracture. Anterior compartment syndrome is at risk as anterior tibial recurrent artery may be disrupted. Meniscal tears have been reported in this population as well. |
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A 14-year-old boy sustains the injury shown in figure A. He subsequently develops compartment syndrome and requires fasciotomy. Injury to what artery is most likely responsible? |
anterior tibial artery lies on the anterior surface of the interosseous membrane and supplies the anterior compartment of the leg. The anterior tibial recurrent artery arises superiorly over the tibial tubercle to supply the anterior knee and can be injured by displaced fractures of the tubercle. |
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___artery is a branch off the posterior tibial artery distal to the knee joint, and descends in the posterior compartment. name 1-21 1-6; 6-3;15-6;18-4 |
peroneal A=13
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___ artery is a branch of the popliteal artery and carries blood to the posterior compartment of the leg and plantar surface of the foot. |
posterior tibial=15
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_____ artery comes off of the popliteal artery and supplies the ACL. |
middle geniculate |
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___ artery pierces the aponeurotic covering of the adductor canal, and accompanies the saphenous nerve to the medial side of the knee. |
saphenous branch of descending genicular |
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The AP radiograph in Figure A demonstrates an injury in a 13-year-old soccer player. What is the equivalent injury in a skeletally mature patient? -dx? |
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___ &___ are thought to be involved in generation of the this ______ fracture. -pathognomonic for an ____ |
iliotibial band and anterior oblique ligaments -Segond -ACL |
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A 19-year-old patient is undergoing an arthroscopic treatment of a right knee with suture fixation via transosseous tunnels shown in the video in Figure V. What is the most likely postoperative complication? |
Intercondylar eminence fractures that occur in adolescent or adult patients need to be counseled as to the risk of development of stiffness and arthrofibrotic scar tissue. This often presents with the inability to achieve full knee extension. |
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A 10-year-old female presents to the emergency department complaining of anterior knee pain after a fall from her bicycle. Exam reveals ecchymosis and swelling over the patella and an extensor lag. Radiographs are shown in Figures A and B. What is the most appropriate next step in treatment? dx? mc Complication? |
open reduction with sutrure fixation -Patella sleeve fractures occur most commonly in children aged 8-12. This injury involves an avulsion of cartilage (and sometimes a small piece of bone) from the inferior pole of the patella. Sleeve fractures should be accurately reduced and stabilized using suture fixation thru bone tunnels in the patella. K wires can be added if the fracture fragment is large enough. -Patella altaExtensor lagQuadriceps atrophy |
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what is the name of the x-ray finding that's pathognomonic for both columns fracture and what view is this finding found? |
spur signed Obturator oblique view |
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2 findings associated with intact weightbearing dome ? |
#1–roof arcs greater than 45° #2–femoral head congruency with intact acetabulum on non-traction x-ray |
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surgical approach has the highest risk of complication due to a vascular issue? |
the Stoppa approach to the acetabulum |
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what is the most common complication with the Stoppa approach? |
injury to the corona mortise |
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what to vessels and anastomosis to form the corona mortise |
the external iliac artery and the obturator artery which is a retropubic vascular connection |
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what is the most important factor for improved outcome after an acetabular fracture postoperatively? |
anatomic reduction |
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there is a disproportionate incidence of poor outcomes in what kind of fractures as relates to the hip? |
posterior wall fractures |
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most common complication after an acetabular fracture is ? |
posttraumatic arthrosis |
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what tests must be ordered for all traumatic hip dislocations? |
postreduction CT scan |
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what is the most important factor affecting a dislocated hip? |
reduction as soon as possible |
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what is the weightbearing status after a dislocated hip with no associated injuries? |
weightbearing as tolerated WBAT postreduction |
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what is the rate of osteonecrosis after all hip dislocations? |
10-15% |
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how much displacement of the femoral head is indication for surgery |
any displacement |
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what is the treatment for Pipkin 1 fracture? what is a Pipkin 1 fracture? |
excise small infra-foveal fragments -type I is below the fovea and does not involve the weightbearing portion of the femoral head |
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what is the treatment for a Pipkin 2 femoral head fracture? what is a Pipkin 2 fracture? |
ORIF super foveal fragments -Pipkin 2 is a fracture above the fovea ligament and involve the weightbearing portion of the femoral head |
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what is a Pipkin 3 femoral head fracture? |
it is an Pipkin 1 or 2 with an associated femoral neck fracture high incidence of AVN |
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what is a Pipkin 4 femoral head fracture |
it is an Pipkin 1 or 2 with an associated acetabular fracture using posterior wall |
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what is the treatment of Pipkin 1 fracture |
nondisplacedToe-touch weightbearing ×4-6 weeks |
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what is the treatment of a Pipkin 3 and an older patient compared to a younger patient |
?older patient treated with an endoprosthesis bipolar and a younger patient is treated with ORIF of the head and the neck |
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what is the single most important factor in the treatment and the outcome number femoral neck fracture? |
the physiologic age of the patient |
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what is the primary source of blood flow to the femoral head? |
the medial femoral circumflex artery |
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what is the next best step to diagnosis an occult fracture of the femoral neck? |
MRI T1 |
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which classification of the femoral neck fracture has the highest risk of complication & why? |
Pauwels 3 because its vertical fracture |
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what is the treatment for a displaced femoral neck fracture and a young patient? |
Internal fixation |
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what is mandatory to get right during the reduction process of the displaced femoral neck fracture in a young patient? |
anatomic reduction |
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what is the treatment for displaced femoral neck fracture in an older patient |
prosthetic replacement unipolar and bipolar |
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what is the treatment of a femoral neck fracture in an older patient with pre-existing disease |
consider total hip arthroplasty |
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was most important risk factor for osteonecrosis after femoral neck fracture |
inaccurate reduction |
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what is the treatment of a nonunion of the femoral neck if the head is viable in a young patient |
valgus intertrochanteric osteotomy |
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what is the most common fracture of the hip that tends to occur an older and sicker patient's? |
intertrochanteric hip fractures |
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hip fractures associated with a decrease mortality are seen is surgery is performed within what time.? |
48 hours |
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what is the literature say about the comparison of a sliding hip screw and sideplate to a cephalometric layer and a nail for the treatment of a neutral hip fracture? |
sliding hip compression screw at the lower complication rate and decreased cost |
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what is the treatment for reverse oblique fracture of the proximal femur? |
fixed angle plate screw construct Cephalomedullary nail |
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in a proximal femur fracture that involved the subtrochanteric regionwhat is the position of the proximal fragments |
the proximal fragments are typically flexed and abducted AKA varus and procavatum |
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what is the preferred treatment for subtrochanteric hip fracture? |
intramedullary fixation |
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what is the most common complicationwith intramedullary fixation of subtrochanteric hip fracture? |
varus malreduction |
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what is the entry point for cephalo-medullary nail? |
piriformis fossa entry |
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what tip to apex distance is associated with a greater cut out of the lateral femoral cortex |
greater than 25 mm |
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what is the most common cause of implant failure with proximal femur fractures |
osteoporosis requiring calcium and vitamin D treatment |
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when treating a basicervical hip fracture what is helpful during surgery? |
a derotation screw |
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when treating surgically a femoral neck fracture what is the orientation of fixation described |
the orientation is inverted triangle with the distal screw being placed in the calcar and posterior |
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what is the most common complication with a femoral shaft fracture which occurs up to 10% of the time? |
ipsilateral femoral neck fracture |
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what is the next step in the management of femoral shaft fracture preop and intraoperative |
preop finding cut CT scan to rule out femoral neck fracture and Intra-Op fluoroscopy views to rule out femoral neck fracture |
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was a treatment of a femoral shaft fracture in damage control surgery? |
external fixation |
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if there is a femoral shaft fracture plus a neck fracture, a periprosthetic fracture, or pediatric femur fracture what is the next step in treatment |
ORIF with plate fixation |
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what is one of the primary treatment goals in a trauma patient with a femoral shaft fracture? However this surgery is high risk if what comorbidity is found? |
early IM nailing Do not use IM nailing instead do an excellent fixation and patient with a closed head injury |
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what is the gold standard treatment for femoral shaft fracture? |
statically locked reamed IM nail |
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what is the starting point for a statically locked reamed IM nail with femur |
piriformis fossa starting point |
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what is not necessarily best for trochanteric entry point |
tip of the trochanter what is best is just lateral to the anatomic axis |
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what is the next step in the management for distal third femoral shaft fracture |
retrograde nailing |
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what are the indications for retrograde nailing of a femoral shaft fracture (5) |
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when performing internal fixation of a femoral shaft fracture what step has been shown to have superior results prior to inserting the nail? |
reaming superior to unreamed |
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what is the next step in management of an ipsilateral femoral neck plus a femoral shaft fracture |
retrograde femoral nail or a side plate plus screws for the neck fracture |
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with the most common complication of IM nailing of a femoral shaft fracture, clinical significance? |
most common complication is heterotopic ossification It is really clinically significant |
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what is the next step in management of a patient with bilateral chest injuries |
unreamed IM nail |
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what is the highest risk factor in treating a patient with bilateral femoral shaft fractures |
high risk of death |
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what is the most common malrotation in treating of femoral shaft fracture and the patient had a supine |
2 much internal rotation |
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was most common complication in treating of femoral shaft fracture in the lateral position |
to much external rotation |
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was most common complication and treating of femoral shaft fracture using traction? |
the fractures reduced to0 long |
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was most common complication in treating a femoral shaft fracture in a cast or nonoperatively? |
the fracture is too short |
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what is the most important potential complication with the distal femur fracture |
popliteal artery injury |
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which surgical treatment is contraindicated for a 33 cc fracture of the distal femur |
non-fixed angle plating |
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was the most common malunion with 33C distal femur fracture |
varus malalignment |
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what is the next best management step to treat a distal femur fracture with articular extension |
locked plating with long working length |
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what is a 33 c distal femur fracture |
complete fracture where the articular fragment is separated from the distal femoral shaft |
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what is the next step in management if the goal is to utilize the fixation device to aid in the reduction |
using a nonlocked compression screws |
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when treating a distal femur fracture what type of fixation provides fixed angle fixation that help to resist collapsed |
locked screws which are inserted after the nonlocked screws |
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where the next step in management for supracondylar femur fracture and periprosthetic fractures |
retrograde nailing |
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when treating a distal femur fracture with the Hoffa fragment what is the direction of fixation and which condyle issues is fractured? |
fixations from anterior to posterior and it involved the lateral femoral condyle |
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what is the next management step if there are diminished distal pulses after gross alignment is restored |
angiography |
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was the incidence of the Hoffa fracture and types the distal femur fractures |
approximate 40% |
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