Essential Orthopedic Review Questions and Answers for Senior Medical Students

Adam E. M. Eltorai Craig P. Eberson Alan H. Daniels Editors

123 Essential Orthopedic Review Adam E. M. Eltorai • Craig P. Eberson Alan H. Daniels Editors

Essential Orthopedic Review

Questions and Answers for Senior Medical Students Editors Adam E. M. Eltorai Craig P. Eberson Warren Alpert Medical School Department of Orthopedic Brown University Surgery Providence, RI Warren Alpert Medical School USA Brown University Providence, RI Alan H. Daniels USA Department of Orthopedic Surgery Warren Alpert Medical School Brown University Providence, RI USA

ISBN 978-3-319-78386-4 ISBN 978-3-319-78387-1 (eBook) https://doi.org/10.1007/978-3-319-78387-1

Library of Congress Control Number: 2018943261

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This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland This book is dedicated to my wonderfully supportive wife Michelle and my children Theodore and Anne, the loves of my life. Alan H. Daniels

To Denise and my boys, who make everything worthwhile. Craig P. Eberson

For Ashley, always. Adam E. M. Eltorai Preface

The book is the ideal, on-the-spot reference for students seeking fast facts on diagnosis and management in orthopedic surgery. Its two-column, question-and-answer format makes it a perfect quick reference. Organized by body part, Essential Orthopedic Review focuses on the most common pathologic entities. Topics include history, typical presentation, relevant anatomy, physical examination, imaging, management, and expected outcomes. Essential Orthopedic Review is the ideal addition to a white coat pocket, allowing busy students to efficiently review fundamental principles in orthopedic surgery. Students can read specific chapters for focused subspecialty review or from cover to cover to lay a general foundation of orthopedic knowledge. Aimed at helping students start their orthopedic journeys on the right foot, this book will serve as a tool to propel students to the next level.

Providence, RI, USA Adam E. M. Eltorai Craig P. Eberson Alan H. Daniels Contents

Part I The Basics 1 Orthopaedic Terminology...... 3 Jeremy E. Raducha 2 Radiology: The Basics...... 5 Hardeep Singh and Sean Esmende 3 Fractures...... 7 Jeremy E. Raducha 4 Dislocations ...... 9 Jacob Babu 5 Orthopedic Emergencies ...... 11 Jacob Babu 6 Principles of Trauma...... 13 Jacob Babu Part II The Upper Extremity 7 Upper Extremity Physical Exam...... 17 Tyler S. Pidgeon 8 Rotator Cuff Pathology ...... 19 Christopher Nacca 9 Adhesive Capsulitis...... 21 Christopher Nacca 10 Calcific Tendinitis ...... 23 Kalpit N. Shah x Contents

11 Proximal Humeral Fracture...... 25 Avi DeLano Goodman 12 Clavicular Fracture ...... 27 Jonathan Hodax 13 AC Joint Separation...... 29 Jonathan Hodax 14 Glenohumeral Joint Pathology...... 31 Devan Patel 15 Upper Extremity Arthroplasty ...... 33 Tyler S. Pidgeon 16 Superior Labrum Anterior to Posterior Lesions. . 35 Jonathan Hodax 17 Biceps Tendon Ruptures...... 37 Kalpit N. Shah 18 Humeral Shaft Fracture ...... 39 Devan Patel 19 Tennis and Golfer’s Elbow (Epicondylitis). . . . 41 Andrew D. Sobel 20 Olecranon Bursitis...... 43 Travis Blood 21 Distal Humerus Fractures...... 45 Devan Patel 22 Olecranon Fracture...... 47 Travis Blood 23 Radial Head Fractures ...... 49 Kalpit N. Shah 24 Coranoid Fracture...... 51 Steven F. DeFroda 25 Elbow Dislocations...... 53 Devan Patel Contents xi

26 Degenerative Joint Disease of the Elbow . . . . . 55 Jeremy E. Raducha 27 Osteoarthritis of the Upper Extremity...... 57 Devan Patel 28 Posttraumatic Arthritis: Elbow ...... 59 Manuel F. DaSilva 29 Radius and Ulnar Shaft Fractures...... 61 Jeremy E. Raducha 30 Monteggia and Galeazzi Fracture/Dislocations. . . 63 Devan Patel 31 Distal Radius and Ulnar Fractures...... 65 Travis Blood 32 Carpal Tunnel Syndrome...... 67 Andrew Paul Harris 33 Cubital Tunnel Syndrome...... 69 Kalpit N. Shah 34 Other Compressive Neuropathies...... 71 Ross Feller 35 Kienbock’s Disease...... 73 Devan Patel 36 De Quervain’s Tenosynovitis...... 75 Jeremy E. Raducha 37 Dupuytren’s Disease...... 77 Andrew Paul Harris 38 Trigger Finger...... 79 Andrew Paul Harris 39 Scaphoid Fractures ...... 81 Andrew Paul Harris 40 Other Carpal Bone Fractures...... 83 Devan Patel xii Contents

41 Lunate and Perilunate Dislocations...... 85 Andrew Paul Harris 42 First Metacarpal Base Fracture...... 87 Travis Blood 43 Skier’s or Gamekeeper’s Thumb...... 89 Steven F. DeFroda 44 Boxer’s Fracture...... 91 Devan Patel 45 Phalangeal Fractures...... 93 Kalpit N. Shah 46 Finger (Phalangeal) Dislocations ...... 95 Tyler S. Pidgeon 47 Metacarpal Fractures...... 97 Tyler S. Pidgeon 48 Traumatic/Revision Finger Amputation...... 99 P. Kaveh Mansuripur 49 Tears of the TFCC...... 101 Avi DeLano Goodman 50 Carpal Instability...... 103 Avi DeLano Goodman 51 Flexor Tendon Injuries...... 105 Andrew D. Sobel 52 Extensor Tendon Injuries...... 109 Devan Patel 53 Nerve Injury...... 111 Ross Feller 54 Replantation...... 115 Steven F. DeFroda 55 Rheumatoid Arthritis and Other Inflammatory Arthritides ...... 117 Ross Feller Contents xiii

56 Degenerative Arthritis of the Hand and Wrist. . . 119 Ross Feller 57 Complex Regional Pain Syndrome...... 121 Ross Feller 58 Hand Infections...... 123 Ross Feller Part III The Lower Extremity 59 External Snapping Hip...... 127 John R. Tuttle 60 Fractures of the Proximal Femur...... 129 Viorel Raducan 61 Native Hip Dislocations...... 133 Viorel Raducan 62 Hip Osteoarthritis...... 137 Stephen Marcaccio 63 Osteonecrosis...... 139 Stephen Marcaccio 64 Total Hip Arthroplasty...... 141 Nicholas Lemme and Alexandre Boulos 65 Femoral Shaft Fractures...... 145 James Levins 66 Ligamentous Knee Injury...... 147 James Levins 67 Meniscal Tear...... 149 Jonathan Hodax 68 Extensor Mechanism Injuries of the Knee . . . . 151 Jonathan Hodax 69 Lower Extremity Tibia and Fibula Shaft Fractures. 153 Tyler S. Pidgeon 70 Distal Femoral Fractures ...... 157 Viorel Raducan xiv Contents

71 Patellar Fractures...... 159 Brian H. Cohen 72 Knee Tendon Rupture (Patellar and Quadriceps Tendons)...... 161 John R. Tuttle 73 Patellar Dislocation...... 163 Steven F. DeFroda 74 Total Knee Arthroplasty...... 165 Alexandre Boulos and Nicholas Lemme 75 Patellofemoral Pain Syndrome ...... 169 Steven F. DeFroda 76 IT Band Syndrome ...... 171 John R. Tuttle 77 Lower Extremity Tibial Plateau Fractures. . . . . 173 Tyler S. Pidgeon 78 Stress Fracture...... 175 John R. Tuttle 79 Metatarsalgia...... 177 Stephen Marcaccio 80 Hallux Valgus...... 179 Rishin J. Kadakia and Jason T. Bariteau 81 Heel Pain ...... 181 Stephen Marcaccio 82 Ankle Sprain/Fracture...... 183 Rishin J. Kadakia and Jason T. Bariteau 83 Talar Fracture...... 185 Gregory R. Waryasz 84 Calcaneus Fracture ...... 187 Rishin J. Kadakia and Jason T. Bariteau 85 Lisfranc Fracture...... 189 Gregory R. Waryasz Contents xv

86 Metatarsal Fracture...... 191 Seth W. O’Donnell and Brad D. Blankenhorn 87 Pilon Fracture...... 193 Seth W. O’Donnell and Brad D. Blankenhorn 88 Achilles Tendon Pathology...... 195 Gregory R. Waryasz 89 Diabetic Foot...... 197 Seth W. O’Donnell and Brad D. Blankenhorn 90 Charcot Arthropathy...... 199 Rishin J. Kadakia and Jason T. Bariteau 91 Tarsal Tunnel Syndrome...... 201 Brian H. Cohen 92 Peroneal Tendon Pathology...... 205 Seth W. O’Donnell and Brad D. Blankenhorn 93 Flatfoot...... 207 Seth W. O’Donnell and Brad D. Blankenhorn 94 Plantar Fasciitis...... 209 Gregory R. Waryasz 95 Morton Neuroma...... 211 Seth W. O’Donnell and Brad D. Blankenhorn 96 Arthritic Foot...... 213 Seth W. O’Donnell and Brad D. Blankenhorn 97 Pelvic Ring Fractures ...... 215 Daniel Brian Carlin Reid 98 Acetabular Fractures...... 217 Daniel Brian Carlin Reid Part IV Spine 99 Vertebral Disc Disease...... 221 Dominic Kleinhenz 100 Spondylolysis and Spondylolisthesis...... 223 Dominic Kleinhenz xvi Contents

101 Spinal Stenosis...... 225 Dominic Kleinhenz 102 Spinal Cord Injury...... 227 Jacob Babu 103 Cervical Fracture/Dislocation ...... 231 Jacob Babu 104 Thoracolumbar Fracture...... 233 Jacob Babu 105 Lumbar Spine Conditions...... 235 Eren O. Kuris 106 Adult Spinal Deformity ...... 239 Dominic Kleinhenz 107 Spine Tumors...... 241 Eren O. Kuris 108 Spine Infections...... 245 Eren O. Kuris Part V Pediatric Orthopedics 109 Angular Variations ...... 251 Heather Hansen 110 Pediatric Fractures: Management Principles. . . . 253 Aristides I. Cruz Jr. 111 Radial Head Dislocation ...... 255 Aristides I. Cruz Jr. 112 Slipped Capital Femoral Epiphysis...... 257 Heather Hansen 113 Congenital Hip Dislocation...... 259 Jose M. Ramirez 114 Congenital Coxa Vara...... 261 Jose M. Ramirez 115 Osteochondrosis (Osgood-Schlatter and Osteochondritis Dissecans)...... 263 Jose M. Ramirez Contents xvii

116 Osteogenesis Imperfecta (OI)...... 265 Jose M. Ramirez 117 Child Abuse...... 267 Jose M. Ramirez 118 Legg-Calve-Perthes Disease...... 269 Jose M. Ramirez 119 Cerebral Palsy ...... 271 Heather Hansen 120 Spinal Bifida...... 275 Daniel Brian Carlin Reid 121 Charcot-Marie-Tooth Disease...... 277 Heather Hansen and Seth W. O’Donnell 122 Muscular Dystrophy ...... 281 Jose M. Ramirez 123 Arthrogryposis...... 283 Jonathan R. Schiller 124 Achondroplasia ...... 285 Heather Hansen 125 Other Skeletal Dysplasia ...... 287 Jonathan R. Schiller 126 Chromosomal and Inherited Syndromes. . . . . 289 Jose M. Ramirez 127 Arthritis...... 291 Jose M. Ramirez 128 Shoulder and Elbow Deformities...... 293 Aristides I. Cruz Jr. 129 Hand and Wrist Deformities...... 295 Aristides I. Cruz Jr. 130 Genu Varum...... 297 Aristides I. Cruz Jr. 131 Genu Valgum...... 299 Aristides I. Cruz Jr. xviii Contents

132 Axial Rotations...... 301 Jose M. Ramirez 133 Limb Deficiency...... 303 Jose M. Ramirez 134 Limb Length Discrepancy ...... 305 Jonathan R. Schiller 135 Pseudarthrosis of the Tibia...... 307 Jonathan R. Schiller 136 Foot and Ankle Deformities ...... 309 Jonathan R. Schiller 137 Idiopathic Scoliosis...... 311 Daniel Brian Carlin Reid 138 Neuromuscular Scoliosis...... 313 Daniel Brian Carlin Reid 139 Congenital Spinal Anomalies...... 315 Daniel Brian Carlin Reid 140 Scheuermann’s Kyphosis...... 317 Daniel Brian Carlin Reid 141 Cervical Spine Disorders (Pediatric) ...... 319 Daniel Brian Carlin Reid 142 Spondylolysis and Spondylolisthesis...... 321 Daniel Brian Carlin Reid 143 Spine Injuries...... 323 Daniel Brian Carlin Reid Part VI Systemic Conditions 144 Septic Arthritis...... 327 Stephen Marcaccio 145 Osteomyelitis...... 329 Adam Driesman Contents xix

146 Necrotizing Fasciitis...... 331 Adam Driesman 147 Osteoarthritis...... 333 Sean Esmende and Hardeep Singh 148 Rheumatoid Arthritis...... 335 Stuart T. Schwartz 149 Crystal-Induced Arthropathy...... 337 James Levins 150 Fibromyalgia...... 339 Deepan Dalal and Pieusha Malhotra 151 Seronegative Spondyloarthropathies ...... 341 Eren O. Kuris 152 Polymyalgia Rheumatica ...... 343 Tina Brar and Joanne Szczygiel Cunha 153 Osteoporosis...... 345 James Levins 154 Rickets and Osteomalacia Review ...... 347 Jeanne Delgado 155 Chronic Kidney Disease-Mineral and Bone Disorder: “Renal Osteodystrophy” ...... 349 Janake Patel and Laura Amorese-O’Connell 156 Paget’s Disease of the Bone...... 351 Janake Patel and Laura Amorese-O’Connell 157 Systemic Lupus Erythematosus...... 353 Tina Brar and Joanne Szczygiel Cunha 158 Osteonecrosis...... 355 Deepan Dalal and Pieusha Malhotra 159 Benign Bone Tumors...... 357 Jose M. Ramirez, Adam Driesman, and Richard Terek xx Contents

160 Malignant Bone Tumors...... 359 Adam Driesman, Jose M. Ramirez, and Richard Terek 161 Myositis...... 361 Stuart T. Schwartz Contributors

Laura Amorese-O’Connell, MD The Warren Alpert Medical School of Brown University, Providence, RI, USA Jacob Babu, MD, MHA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA Jason T. Bariteau, MD Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA Brad D. Blankenhorn, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA Travis Blood, MD Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, USA Alexandre Boulos, MD Department of Orthopaedics, Brown University, Providence, RI, USA Tina Brar, MD Division of Rheumatology, The Warren Alpert School of Medicine of Brown University, Providence, RI, USA Brian H. Cohen, MD Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA Aristides I. Cruz Jr., MD, MBA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA xxii Contributors

Joanne Szczygiel Cunha, MD Division of Rheumatology, The Warren Alpert School of Medicine of Brown University, Providence, RI, USA Deepan Dalal, MD, MPH Department of Medicine- Rheumatology, Brown University, Providence, RI, USA Manuel F. DaSilva , MD Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA Steven F. DeFroda, MD, ME Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA Jeanne Delgado, MD Children’s National Medical Center, Washington, DC, USA Adam Driesman, MD Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA Drs. Ramirez and Terek are at associated with Brown University, Providence, RI, USA Sean Esmende, MD Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut School of Medicine, Farmington, CT, USA Orthopedic Associates of Hartford, Division of Spine Surgery, The Bone and Joint Institute, Hartford Hospital, Hartford, CT, USA Ross Feller, MD The Warren Alpert Medical School of Brown University, Providence, RI, USA Avi DeLano Goodman, MD Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, USA Heather Hansen, MD Division of Pediatric Orthopaedic Surgery, Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, RI, USA Andrew Paul Harris, MD Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA Contributors xxiii

Jonathan Hodax, MD, MS Department of Orthopedics, Rhode Island Hospital, Providence, RI, USA Rishin J. Kadakia, MD Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA Dominic Kleinhenz, MD Rhode Island Hospital Orthopaedic Surgery Residency Program, Brown University of Warren Alpert School of Medicine, Providence, RI, USA Eren O. Kuris, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA Nicholas Lemme, MD Department of Orthopedics, Brown University, Providence, RI, USA James Levins, MD Department of Orthopaedic Surgery, Brown University, Providence, RI, USA Pieusha Malhotra, MD, MPH Department of Medicine- Rheumatology, Roger Williams Medical Center, Providence, RI, USA P. Kaveh Mansuripur, MD Hand and Upper Limb Surgery, Stanford University School of Medicine, Stanford, CA, USA Stephen Marcaccio, MD Department of Orthopaedic Surgery, Rhode Island Hospital, Brown University, Providence, RI, USA Christopher Nacca, MD Department of Orthopaedics, Warren Alpert School of Medicine at Brown University, Providence, RI, USA Seth W. O’Donnell, MD Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA Devan Patel, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA xxiv Contributors

Janake Patel, MD Roger William Medical Center, Boston University, Boston, MA, USA Tyler S. Pidgeon, MD Department of Orthopaedic Surgery, The Warren Alpert Medical School at Brown University, Providence, RI, USA Viorel Raducan, MD, FRCS(C) Department of Orthopaedic Surgery, Marshall University School of Medicine, Huntington, WV, USA Jeremy E. Raducha, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA Jose M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA Daniel Brian Carlin Reid, MD, MPH Department of Orthopaedics, Rhode Island Hospital, Brown University, Providence, RI, USA Jonathan R. Schiller, MD Adolescent and Young Adult Hip Program, Orthopaedic Surgery, The Warren Alpert School of Medicine of Brown University, Providence, RI, USA Division of Pediatric Orthopaedics and Scoliosis, Hasbro Children’s Hospital, Rhode Island Hospital, Providence, RI, USA Division of Sports Medicine, Hasbro Children’s Hospital, Rhode Island Hospital, Providence, RI, USA Stuart T. Schwartz, MD Alpert Medical School of Brown University, Providence, RI, USA Kalpit N. Shah, MD Department of Orthopaedic Surgery, Warren Alpert School of Medicine at Brown University, Providence, RI, USA Hardeep Singh, MD Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut School of Medicine, Farmington, CT, USA Contributors xxv

Andrew D. Sobel, MD Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, RI, USA Richard Terek, MD Warren Alpert Medical School of Brown University, Providence, RI, USA John R. Tuttle, MD, MS Sports Medicine, Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA Gregory R. Waryasz, MD, CSCS Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA Part I The Basics

1 Chapter 1 Orthopaedic Terminology

Jeremy E. Raducha

What do the ORIF? A: Open reduction following and internal fixation abbreviations CRPP? A: Closed reduction and stand for? percutaneous pinning WBAT? A: Weight bearing as tolerated NWB? A: Non weight bearing FROM? A: Full range of motion THA? A: Total hip arthroplasty TKA? A: Total knee arthroplasty (continued)

American Academy of Orthopaedic Surgery. AAOS—OrthoInfo: Glossary. American Academy of Orthopaedic Surgery webpage. http:// orthoinfo.aaos.org/glossary.cfm. Published 2017. Accessed 24 Apr 2017.

J. E. Raducha, MD Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA

(continued) What is an open Fracture with communication between fracture? the bone and outside of the skin What is the Ligament connects bone to bone, tendon difference between connects muscle to bone a ligament and a tendon? What is an external Device positioned with pins into the two fixator? ends of a fractured bone or dislocation with bars outside of the skin. It is used to immobilize bones and joints. Most commonly used while waiting for soft tissues to become appropriate for internal fixation Define arthroplasty Reconstructive surgery of a joint (i.e. joint replacement) Define arthrodesis Surgical fusion of a joint Define Removal of fluid from a joint arthrocentesis Define osteotomy Surgical procedure that changes the alignment of bone Define arthroscopy Surgical procedure to diagnose and treat problems inside a joint using a minimally invasive scope Define sprain Partial or complete tear of a ligament Define strain Partial or complete tear of a muscle or tendon Define varus Distal segment angled toward anatomic midline Define valgus Distal segment angled away from anatomic midline Chapter 2 Radiology: The Basics Hardeep Singh and Sean Esmende

What is a systematic approach ABCS in reading an X-ray? A: Adequacy and alignment B: Bones C: Cartilage (including joint spaces) S: Soft Tissues (effusions and swelling) What is the appropriate Plain X-rays in orthogonal initial study to obtain when planes of the affected extremity suspecting a fracture? (continued)

H. Singh, MD Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut School of Medicine, Farmington, CT, USA e-mail: [email protected]

S. Esmende, MD (*) Orthopedic Associates of Hartford, Division of Spine Surgery, The Bone and Joint Institute, Hartford Hospital, Hartford, CT, USA

© Springer International Publishing AG, part of Springer Nature 2018 5 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_2 6 H. Singh and S. Esmende

(continued) What is the study of choice Magnetic resonance imaging when suspicious of a stress (MRI) of the affected extremity fracture? What is an important study Computed tomography (CT) to obtain when evaluating a of the affected extremity for fracture with intraarticular surgical planning extension? Which imaging study allows Magnetic resonance imaging for assessment of soft tissue, (MRI) ligaments, and tendons? Which are the five Air, Fat, Soft tissue/Fluid, radiographic densities? Mineral, and Metal What are the advantages of a Allows for multiplanar CT scan over X-rays? visualization with the ability to reconstruct images to examine fine bony anatomy How is a fracture identified on Disruption (complete or an X-ray? incomplete) in the cortex of a bone How are displacement, With respect to the relationship angulation, shortening, and of the distal fragment to the rotation described on imaging proximal fragment studies? Chapter 3 Fractures Jeremy E. Raducha

What pattern of fracture is demonstrated a) Segmental in images A–E? b) Comminuted c) Sprial d) Oblique d) Transverse

a bcde

What fracture segment Distal segment is used to determine the direction of angulation? (continued)

J. E. Raducha, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) Define pathological Fracture through abnormal bone (e.g. fracture osteoporosis, tumour) Define non-union Failure of fractured bone pieces to fuse together after typically sufficient healing time What are the main types Hypertrophic, oligotrophic, of non-union? and atrophic Define malunion Fusion of fractured bone pieces in inappropriate alignment Define delayed union Longer than expected duration for fusion of fractured bone pieces What system is used to Gustilo and Anderson grading system classify open fractures? What type of antibiotic First-generation cephalosporin (e.g. is given for a Grade I cefazolin) or II open fracture? How long does the 6–8 weeks average bone take to heal? Which type of bone Cancellous heals faster, cortical or cancellous? Chapter 4 Dislocations

Jacob Babu

What is a feared long-term Post-traumatic arthritis complication of any joint dislocation? What is the most frequently Shoulder dislocated joint in the body? What type of upper extremity Posterior shoulder dislocation is commonly missed dislocation and should be kept in mind? What is one of the biggest Recurrent instability concerns of shoulder dislocation (young) vs. rotator cuff tears in the young vs. elderly patient (elderly) population? (continued)

J. Babu, MD, MHA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA e-mail: [email protected]

(continued) What structures are injured in volar Central slip and volar plate and dorsal dislocation of the hand PIP joint, respectively? What are the important physical Internal rotation(posterior exam findings suggestive of dislocation) vs. external direction of hip dislocation? rotation(anterior dislocation) of the leg accompanied by extremity shortening What is a major potential Avascular necrosis (AVN) complication of a hip dislocation? of the femoral head What is the appropriate initial Immediate attempted management for a suspected knee reduction via direct axial dislocation with asymmetric pedal traction pulses? What is the structure most likely to Posterior tibial tendon block reduction of a lateral subtalar dislocation? Chapter 5 Orthopedic Emergencies Jacob Babu

What should be urgently Open reduction if closed done if skin-tenting overlying reduction is not successful in a fracture is noticed? relieving skin pressure What are two of the most Time to antibiotics and transfer important factors determining to Level 1 Trauma Center outcome after an open fracture? What is the classification Gustilo–Anderson classification system commonly utilized to describe open fractures? What should be done next Ankle Brachial Index if diminished pulses are appreciated in a traumatic lower extremity injury? (continued)

J. Babu, MD, MHA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA e-mail: [email protected]

(continued) What physical exam Pain, pallor, paresthesias, findings can be suggestive of pulselessness, paralysis compartment syndrome? What diagnostic test can Compartment pressure help practitioners identify measurements compared compartment syndrome? to diastolic blood pressure. DBP—CP <30 is indicative of compartment syndrome What cell count from a joint Nucleated cell counts greater aspiration can be suggestive than 50–80,000 of a septic joint? What is a major consequence Articular cartilage destruction of a missed septic joint? from bacterial toxins and inflammatory cell enzymes What utility can be obtained Identifying a disc herniation and from performing an MRI optimal approach for stabilization prior to reduction of a of fracture/dislocation cervical facet dislocation? What are some of the red flag Bowel/bladder incontinence symptoms of a lumbar disc or retention, saddle anesthesia, herniation which may indicate progressive extremity weakness cauda equina syndrome? and numbness Chapter 6 Principles of Trauma Jacob Babu

What class of shock and what Class II Shock and loss of percentage of total body blood 15–30% blood volume loss are indicated by normal blood pressure with an elevated heart rate? Transfusion of what blood products Red blood cells, platelets, are indicated in a 1:1:1 ratio? plasma What serum marker value is Serum lactate levels indicative of adequate resuscitation? <2 mmol/L How much blood can be lost into 1–2 L the thigh from a single femur fracture? (continued)

J. Babu, MD, MHA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA e-mail: [email protected]

(continued) What Injury Severity Score (ISS) An ISS of 15. ISS = sum is considered a major trauma with of the squares of the three >10% mortality? highest Abbreviated Injury Scores (AIS) What should be done if pelvic Placement of pelvic binder instability is identified by exam or clamped bedsheet and radiograph and the patient is centered around patient’s hemodynamically unstable? greater trochanters What X-ray views can help better Inlet and outlet views identify pelvic ring fractures? What are the options of damage External fixation and control orthopedics management of skeletal traction a long bone fracture? What radiographic finding is Displacement of the edge indicative of a scapulothoracic of scapula from the spinous dissociation? process by >1 cm from the contralateral side Is lower extremity trauma an Yes indication for internal fixation of an otherwise uncomplicated humeral shaft fracture? Part II The Upper Extremity

15 Chapter 7 Upper Extremity Physical Exam Tyler S. Pidgeon

What structure is likely affected in a The Triangular patient with a positive fovea sign? Fibrocartilage Complex (TFCC) Allen’s test evaluates the The ulnar artery and the connection of which two arteries radial artery with the palmar arches of the hand? A positive Obrien’s test is The glenoid labrum suspicious for an injury to what shoulder structure? A patient with an abnormal hook Supination test at the elbow would be most likely to have weakness with what motion of the forearm? Finkelstein’s test evaluates patients De Quervain’s for what wrist condition? tenosynovitis (tenosynovitis of the first dorsal compartment of the wrist) (continued)

T. S. Pidgeon, MD Department of Orthopaedic Surgery, The Warren Alpert Medical School at Brown University, Providence, RI, USA

(continued)

What is the most sensitive physical Durkan’s carpal exam special test for the diagnosis compression test of carpal tunnel syndrome? A patient with pain during resisted Lateral epicondylitis wrist extension with an extended elbow is most likely to have what condition? Describe the performance and The patient is supine on findings of apprehension testing in the examination table a patient with suspected shoulder to stabilize the scapula. instability The shoulder is passively externally rotated by the examiner with the shoulder abducted and the elbow flexed to 90o. The patient complains of pain or apprehension that the shoulder will dislocate with increasing external rotation. Symptoms are improved when the examiner applies anterior to posterior pressure over the shoulder Testing of thumb interphalangeal The anterior interosseous joint flexion strength and index nerve (branch of the finger distal interphalangeal joint median nerve) strength examines the function of what nerve? Positive Tinel’s sign over the Cubital tunnel syndrome medial elbow is suggestive of what (ulnar nerve compression condition? neuropathy) Chapter 8 Rotator Cuff Pathology Christopher Nacca

How many rotator cuff tendons Four exist? Name the rotator cuff tendons Supraspinatus, infraspinatus, [1, 2]. subscapularis, teres minor What is the innervation of the Axillary nerve Teres minor? Where does the subscapularis Lesser tuberosity insert? Which side of the tendon do Articular side most tears occur? Name structures within the Capsule, SGHL, rotator interval. coracohumeral ligament (continued)

C. Nacca, MD Department of Orthopaedics, Warren Alpert School of Medicine at Brown University, Providence, RI, USA

(continued)

Majority of tears include which Supraspinatus, infraspinatus tendons? Which symptom is a poor Night pain indicator for nonoperative management? Hornblower’s sign is often Teres minor associated with which tendon tear? What is the treatment for Reverse total shoulder patients with massive rotator arthroplasty cuff tears and associated glenohumeral arthritis

References

1. Millett PJ, Warth RJ. Posterosuperior rotator cuff tears. J Am Acad Orthop Surg. 2014;22(8):521–34. https://doi.org/10.5435/ JAAOS-22-08-521. 2. Murray J, Gross L. Optimizing the management of full-thickness rotator cuff tears. J Am Acad Orthop Surg. 2013;21(12):767–71. https://doi.org/10.5435/JAAOS-21-12-767. Chapter 9 Adhesive Capsulitis Christopher Nacca

Which structure in the shoulder is Joint capsule most often involved? [1] How many stages of progression Four are there? What is the most common Pain of insidious onset over presentation? several months Patients often complain having Sleeping on affected side, difficulty with which activities? combing hair, or reaching behind back Who are the most common Women aged 40–60 years old demographic affected? Which endocrine disorders are Diabetes and hypothyroidism often implicated? How is this condition best Physical exam diagnosed? (continued)

C. Nacca, MD Department of Orthopaedics, Warren Alpert School of Medicine at Brown University, Providence, RI, USA

(continued) Which exam finding is most Limited passive range of specific? motion in external rotation What is the mainstay of Intra-articular corticosteroid treatment? injection and physical therapy How much time may it take for Up to 2 years resolution of symptoms with nonoperative treatment?

References

1. Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2011;19(9):536–42. http://www.ncbi.nlm. nih.gov/pubmed/21885699. Accessed 12 Jul 2017. Chapter 10 Calcific Tendinitis Kalpit N. Shah

What is calcific tendinitis? Calcification and tendon deposition of the rotator cuff tendons at their insertion on the humerus Who are the typical Women aged 30–60 years patients that develop calcific tendinitis? Which is the most common Supraspinatus tendon involved? Which medical Endocrine abnormalities— comorbidities are risk Hypothyroidism, diabetes factors? What are the three phases Formative (calcium deposits being of calcific tendinitis? made) Resting (no inflammatory activity) Resorptive (phagocytic resorption—inflammatory mediators cause a significant amount of pain) (continued)

K. N. Shah, MD Department of Orthopaedic Surgery, Warren Alpert School of Medicine at Brown University, Providence, RI, USA

(continued) Which physical exam Subacromial impingement tests maneuvers are positive? What imaging modality is Shoulder radiographs should show ideal? the calcium deposits at the insertion side of the various tendons Where are the calcium 1–1.5 cm away from the tendon deposits located? insertion What is the first-line Conservative: NSAIDs, therapy— treatment for calcific stretching, strengthening, +/− tendinitis? steroid injections What % of patients will 60–70% of patients by 6 months improve with nonoperative management? What are the treatment Extracorporeal shockwave therapy options if patient fails Needle barbotage conservative management? Surgical debridement Chapter 11 Proximal Humeral Fracture Avi DeLano Goodman

What X-ray views are Trauma series: true AP, axillary needed? lateral, scapular Y What defines a “part” in 1 cm displacement or 45° angulation. the Neer classification? Parts can be: greater tuberosity, lesser tuberosity, articular surface, and shaft Which is the most Surgical neck (85%) common type of fracture? What is the incidence of 45%, axillary nerve nerve injury, and which nerve is most commonly injured? What is the blood supply Anterior humeral circumflex artery to the humeral head? (old data), posterior humeral circumflex artery (new data) (continued)

A. D. Goodman, MD Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is attached to each Greater: rotator cuff (will displace tuberosity? superiorly and posteriorly) Lesser: subscapularis (will rotate internally) When to consider Minimally displaced, greater nonoperative tuberosity displacement <5 mm, low management? demand, otherwise not medically able to undergo surgery What are the surgical ORIF, intramedullary nail, CRPP, options? and arthroplasty (hemiarthroplasty, anatomic total, and reverse total) What are the common Intraarticular screw penetration, complications? avascular necrosis, malunion, nonunion, rotator cuff injury, posttraumatic arthritis, stiffness Chapter 12 Clavicular Fracture Jonathan Hodax

How is the clavicle formed in Intramembranous ossification embryology and childhood development? What is special about First bone to begin to ossify, last the clavicle’s timing of to finish ossification? What side does congenital RIGHT side, believed to be pseudoarthrosis of the because of the brachiocephalic clavicle typically occur on artery and why? How are clavicle fractures Medial, middle, and lateral third typically grouped? How are medial clavicle Anterior versus posterior fractures classified? displacement (continued)

J. Hodax, MD, MS Department of Orthopedics, Rhode Island Hospital, Providence, RI, USA

(continued) How are middle third clavicle Typically displaced versus fractures classified? nondisplaced, comminuted versus not How are lateral third clavicle Neer classification, type I–V fractures classified? What ligaments attach to the Costoclavicular ligament medially, clavicle? and the conoid and trapezoid coracoclavicular ligaments laterally What are the absolute Open fracture, threatened skin, indications to operate on subclavian injury a middle third clavicle fracture? What are the relative Displacement greater than 100%, indications to operate on “Z” deformity, comminution, a middle third clavicle shortening more than 2 cm, fracture? polytrauma What is the most common Hardware removal cause for reoperation after fixation of clavicle fractures? Chapter 13 AC Joint Separation Jonathan Hodax

How are AC By the Rockwood classification separations classified? I: Symptomatic sprain without radiographic displacement II: Coracoclavicular interval widening of up to 25% compared with contralateral III: Coracoclavicular interval widening of 25–100% IV: Clavicle displaced posteriorly into/ through trapezius V: Clavicle displaced more than 100% superiorly, lateral end through deltotrapezial fascia VI: Inferiorly displaced lateral clavicle, with clavicle resting posterior to coracobrachialis tendon What X-rays are best Zanca view and comparative images of to evaluate AC joint the uninjured shoulder injuries? (continued)

J. Hodax, MD, MS Department of Orthopedics, Rhode Island Hospital, Providence, RI, USA

(continued) What AC separations Type IV and higher are generally are appropriate for operatively treated. Type III are surgical intervention? operative in athletes or those who fail nonop treatment What surgical Allograft reconstruction with tendon techniques exist for looped around the coranoid, screw repairing the AC fixation to the coranoid, and suture joint? fixation of the clavicle to the coranoid What portion of the The posterosuperior joint capsule AC joint capsule is strongest? Chapter 14 Glenohumeral Joint Pathology Devan Patel

Is anterior or posterior Anterior instability more common? What is TUBS? Traumatic unilateral shoulder dislocations, with a Bankart lesion often requiring surgery What is AMBRI? Atraumatic multidirectional bilateral shoulder dislocation often requiring rehabilitation and occasionally requiring inferior capsular shift What is a Bankart lesion? Disruption of the anterior inferior glenoid labrum, often a result of anterior shoulder dislocations What is a Hill Sachs Impaction injury to the posterior lesion? superior humeral head, often seen after an anterior dislocation (continued)

D. Patel, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the “lightbulb” Appearance of the humeral head sign? in internal rotation on an AP radiograph seen after a posterior shoulder dislocation What is a HAGL lesion? Humeral avulsion of the inferior glenohumeral ligament, most commonly seen after an anterior shoulder dislocation What incidents typically High-energy trauma, seizures, and cause posterior electrocution accidents dislocations? Which muscle group is the Shoulder internal rotators overpower primary cause of posterior external rotators shoulder dislocations? What portion of the Posterior glenoid glenoid typically appears most worn in osteoarthritis of the glenohumeral joint? Chapter 15 Upper Extremity Arthroplasty Tyler S. Pidgeon

Total shoulder arthroplasty is Rotator cuff deficiency contraindicated in patients with what (large and irreparable soft-tissue shoulder pathology? full-thickness tears/non- functional rotator cuff/ rotator cuff arthropathy) What shoulder arthroplasty options Reverse total shoulder are available to patients with rotator arthroplasty and shoulder cuff deficiency? hemiarthroplasty Reverse total shoulder arthroplasty Deltoid function relies on the function of what muscle? Total shoulder arthroplasty in Glenoid component patients with rotator cuff deficiency loosening and failure fails most commonly by what mechanism? (continued)

T. S. Pidgeon, MD Department of Orthopaedic Surgery, The Warren Alpert Medical School at Brown University, Providence, RI, USA

(continued) What indication for total elbow Rheumatoid arthritis arthroplasty results in the longest survivorship? What is the lifelong lifting restriction Repetitive activity: 2 for patients who have undergone pounds; Single lift activity: total elbow arthroplasty? 5–10 pounds The latest generation (fourth 90–97% generation) total wrist arthroplasty designs have approximately what 5-year survival rate? Thumb carpal-metacarpal (CMC) The trapezium joint arthroplasty most commonly involves resection of what carpal bone? Attenuation of what ligament is The anterior oblique thought to be a major contributing (Beak) ligament (primary cause of thumb CMC arthritis? stabilizer of the thumb CMC joint) Silicon metacarpophalangeal Rheumatoid arthritis (MCP) joint replacement of the index, middle, ring, and small finger during the same operation is most commonly performed for patients with what disease? Chapter 16 Superior Labrum Anterior to Posterior Lesions Jonathan Hodax

How are SLAP tears By the Tuoheti classification classified? I: Fraying of the superior labrum with an intact biceps anchor II: Superior labral detachment with detachment of the biceps anchor III: Bucket-handle type tear of the superior labrum, biceps anchor intact IV: Bucket handle tear of the labrum with extension into the biceps tendon, anchor partially intact How are SLAP tears Type I: Debride frayed edge typically treated? Type II: Debride and reattach biceps and labrum Type III: Resect tear, anchor free edges if needed Type IV: Resect tear. If >50% of biceps tendon involved, consider tenodesis (continued)

J. Hodax, MD, MS Department of Orthopedics, Rhode Island Hospital, Providence, RI, USA

(continued) In what population Overhead throwing athletes are SLAP tears most clinically significant? What is a cordlike A Buford complex, and NO! MGHL with absence of the anterior labrum called? And should this be repaired down? What is the major Overconstraint of the biceps tendon surgical pitfall to leading to reduced range of motion avoid in SLAP repairs? Chapter 17 Biceps Tendon Ruptures Kalpit N. Shah

Where do the two heads of Coracoid process (short head) the biceps tendon originate and the superior glenoid (long from? head) Where does the biceps Bicipital tuberosity of the radius tendon attach distally? Long head attaches proximally Short head attaches distally Where does the lacertus Comes off the medial side of the fibrosus originate and insert? short head of the biceps tendon in the antecubital fossa Crosses the antecubital fossa and is continuous with the deep fascia of the flexor muscle bellies What innervate the biceps Musculocutaneous nerve muscle? (continued)

K. N. Shah, MD Department of Orthopaedic Surgery, Warren Alpert School of Medicine at Brown University, Providence, RI, USA

(continued) What type of contraction Eccentric contraction—forced leads to tendon injury? elbow extension when flexed Can patients with biceps Yes, brachialis muscle is the tendon rupture flex their primary elbow flexor. Biceps elbow? brachii contributes 30% of elbow flexion strength Can patients with biceps Yes, supinator contributes to tendon ruptures supinate forearm supination. Biceps brachii their arm? contributes roughly 40–50% of the supination strength Physical exam test to assess Hook test—examiner tries to distal biceps tendon? hook their index finger into the patient’s biceps tendon in the antecubital fossa If a patient has a known Lacertus fibrosus distal biceps tear, but still has a negative hook test, what structure is the examiner palpating? What deformity does a Popeye deformity patient with a biceps rupture have on examination? Best imaging test to evaluate MRI with the forearm flexed, for this injury? supinated, and shoulder abducted What nerve is at risk of being Posterior interosseous nerve and injured during surgical repair lateral antebrachial cutaneous of distal biceps tendon? nerve Chapter 18 Humeral Shaft Fracture Devan Patel

How can humeral shaft Transverse, oblique, spiral, comminuted fracture patterns be with or without butterfly fragments described? What are the primary Pectoralis major: adducts proximal deforming forces of fracture fragments humeral shaft fractures? Deltoid: abducts proximal fracture fragments What are the maximum Malrotation: 15° acceptable reduction Anterior angulation: 20° criteria for nonoperative Varus: 30° management? Shortening/bayonet opposition: 3 cm (continued)

D. Patel, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the classic High energy trauma → direct mechanism of humeral force → transverse and comminuted shaft fractures? fractures Indirect trauma (fall on outstretched hand) → rotational forces → spiral fracture patterns What are some Radial nerve injuries, brachial plexus associated injuries, and profunda brachii arteries neurovascular injuries with humeral shaft fractures? What are the Open fractures, unacceptable reduction indications for operative criteria, radial nerve palsy after management? reduction, ipsilateral upper extremity injuries, pathological fractures, and segmental fractures What is the most Coaptation splint followed by common nonoperative Sarmiento brace or casting treatment? What are the operative Intramedullary nail, plate fixation, and treatments for humeral external fixation shaft fractures? Common complications Radial nerve palsy, malunion, delayed of a humeral shaft union, non-union fracture include? Chapter 19 Tennis and Golfer’s Elbow (Epicondylitis) Andrew D. Sobel

What is the most common Extensor carpi radialis brevis muscle origin affected (ECRB) in tennis elbow (lateral epicondylitis)? What is the histopathology of Angiofibroblastic hyperplasia and lateral epicondylitis? disorganized collagen What are the two most Tenderness to palpation at lateral common findings on epicondyle/insertion of ECRB examination of lateral Pain with wrist extension epicondylitis? against resistance What is a common non- Radial tunnel syndrome which traumatic condition that can has pain more distal (3–4 cm) often be confused with lateral from the lateral epicondyle and epicondylitis and how can you pain with extension of the long differentiate them on exam? finger (continued)

A. D. Sobel, MD Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What is the most effective Nonoperative with grip training treatment for lateral (gripping/lifting with forearm epicondylitis? supinated instead of pronated), physical therapy, corticosteroid injections, etc. What is the cause of golfer’s Repetitive eccentric loading of elbow (medial epicondylitis)? flexor-pronator mass usually affecting all muscles except the palmaris longus What neurologic disorder is Ulnar nerve compression/neuritis often concomitantly present with medial epicondylitis? What are classic exam Tenderness to palpation 5–10 mm findings for medial distal and anterior to the medial epicondylitis? epicondyle and pain/weakness with resisted wrist flexion, forearm pronation, or grip What is the most effective Nonoperative with counterforce treatment for medial bracing/taping, flexor-pronator epicondylitis? mass stretching/strengthening. Corticosteroid injections should not be repeated multiple times Chapter 20 Olecranon Bursitis Travis Blood

What blood tests should CBC with differential, ESR, CRP be obtained with suspected infectious olecranon bursitis? What can you do to test the Sterile aspiration fluid of the bursa? What should you send the Gram stain and culture aspiration for? What is the most likely Staphylococcal aureus organism that is isolated from infected elbow bursitis? What nerve is on the medial Ulnar nerve side of the olecranon? Is elbow bursitis usually Non-painful painful or non-painful?

T. Blood, MD Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

© Springer International Publishing AG, part of Springer Nature 2018 43 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_20 Chapter 21 Distal Humerus Fractures Devan Patel

What is the general OTA/AO classification of distal A—Extra-artricular (supracondylar) humerus fractures? B—Partial articular (single column) C—Complete articular (bicolumn) What is the classification The Milch classification system system for partial articular I: Lateral trochlear ridge intact single column fractures? II: Fracture through the lateral trochlear ridge What is the classification The Jupiter classification system system for complete articular bicolumn fractures? What imaging modality is Computed tomography (CT) important to better define scanning these fracture patterns? (continued)

D. Patel, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the “double arch” Seen on lateral radiographs in sign? coronal sheer fractures of the capitellum. When is nonoperative Nondisplaced fractures, patients who management the are not surgical candidates due to treatment of choice? other medical comorbidities, and advanced dementia What is the “bag of bones” Nonoperative treatment of distal technique? humerus fractures in a sling, used in patients with severe medical comorbidities What are some operative Closed reduction with percutaneous options? pinning, open reduction internal, distal humeral replacement, and total elbow arthroplasty What are the surgical Triceps splitting, triceps sparing, approaches to the elbow? triceps reflecting, and olecranon osteotomy What are some common Stiffness, heterotopic ossification, complications? ulnar nerve palsy, nonunion, and malunion Chapter 22 Olecranon Fracture Travis Blood

What tendon attaches to the Triceps tendon posterior olecranon? What is the most common Tension-band wiring treatment option for a simple transverse olecranon fracture? What articulates with the Trochlea of the distal humerus greater sigmoid notch of the ulna to form one of the elbow joints? What is the purpose of the Increase extension arc olecranon fossa of the elbow? of motion and decrease impingement (continued)

T. Blood, MD Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) If there is an olecranon fracture Anteriorly and dislocation of the radius what direction will the radius most likely dislocate? What are the treatment Tension band wiring, plate and options for displaced olecranon screw fixation, intramedullary fractures? rod, excision and triceps advancement What is the number one reason Removal of hardware, hardware for return to operating room irritation after fixation of olecranon fracture? Chapter 23 Radial Head Fractures Kalpit N. Shah

What position of the arm Elbow fully extended and forearm during a fall causes a radial pronated fracture? What is the terrible triad of Elbow dislocation, radial head the elbow? fracture, and coronoid fracture What is an Essex-Lopresti Radial head fracture, interosseous injury? membrane disruption, DRUJ injury Most common classification Mason classification for radial head fractures? Type I: Nondisplaced Type II: Displaced (>2 mm) with rotation block Type III: Comminuted and displaced Type IV: Elbow dislocation + radial head fracture (continued)

K. N. Shah, MD Department of Orthopaedic Surgery, Warren Alpert School of Medicine at Brown University, Providence, RI, USA

(continued) How to assess a block to Aspirate elbow hematoma and forearm rotation in the inject lidocaine (reduces pain setting of a radial head associated with the fracture) fracture? What is important if Early ROM (after few days in a managing a nondisplaced sling) to avoid elbow stiffness radial head nonoperatively? Surgical treatment options ORIF, partial excision, full excision, for radial head fractures? radial head replacement Fragments under what size Fragments<25% radial head should be excised? articular surface should be excised How to decide between Replace the radial head if more fragment excision vs. radial than three fragments need to be head replacement? excised Which nerve is at risk PIN—Avoid damaging this nerve during a surgical approach with pronation of the forearm to the radial head? What are safe zones for 90° arc on the radial head that is in ORIF of radial head? line with the radial styloid to the bicipital tuberosity Chapter 24 Coranoid Fracture Steven F. DeFroda

What injury is most associated with Elbow dislocation coranoid fracture? What important anatomic structure Anterior capsule of the attaches just distal to the coranoid elbow tip? What is a “terrible triad” injury? Coranoid fracture, elbow dislocation, radial head fracture Define the Regan and Morrey Type 1: Coranoid tip classification Type 2: <50% of coranoid Type 3: >50% of coranoid Is the coranoid an intra- or Intra-articular extra-articular structure? Where does the medial ulnar Medial facet collateral ligament insert?

S. F. DeFroda, MD, ME Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

References

1. Chen NC, Ring D. Terrible triad injuries of the elbow. J Hand Surg Am. 2015;40(11):2297–303. https://doi.org/10.1016/j.jhsa.2015. 04.039. Chapter 25 Elbow Dislocations Devan Patel

How are elbow dislocation The olecranon (distal) compared discribed in terms of to the humerus (proximal) direction? What is the most common Posterolateral type of elbow dislocation? What are the primary static Joint capsule, anterior bundle stabilizers of the elbow? of the medial collateral ligament, lateral collateral ligament complex, joint congruity What are the dynamic Anconeus, brachailis, and triceps stabilizers of the elbow? In what direction do the Lateral to medial, from the LCL stabilizing elements of to the MCL the elbow fail during a dislocation? (continued)

D. Patel, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What are surgical Open injuries, gross instability indications for an elbow of the elbow, and other elbow dislocation? fractures that warrant operative intervention What is the typical 90° of flexion with forearm position of splinting elbow pronation dislocations? What is the terrible triad? Elbow dislocation with a radial head and coronoid fracture What are the complications Stiffness, pain, and instability of elbow dislocations? Chapter 26 Degenerative Joint Disease of the Elbow Jeremy E. Raducha

What type of collagen is found Type II collagen most commonly in articular cartilage? What are the three articulations Ulnotrochlear, of the elbow? radiocapitellar, and proximal radioulnar joints What is the most common cause Rheumatoid arthritis of elbow arthritis? (continued)

Sanchez-Sotelo J, Morrey BF. Total elbow arthroplasty. J Am Acad Orthop Surg. 2011;19(2):121–5. http://www.ncbi.nlm.nih.gov/pubmed/ 21292935. Accessed 24 Apr 2017. Kokkalis ZT, Schmidt CC, Sotereanos DG. Elbow arthritis: current concepts. J Hand Surg Am. 2009;34(4):761–8. doi:10.1016/j.jhsa.2009.02.019. Soojan MG, Kwon YW. Elbow arthritis. Bull NYU Hosp Jt Dis. 2007;65(1):61–71. http://presentationgrafix.com/_dev/cake/files/archive/ pdfs/526.pdf. Accessed 26 Apr 2017.

J. E. Raducha, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) Which motion is typically lost first Terminal extension in elbow arthritis? Which nerve is most likely affected Ulnar nerve by end stage elbow arthritis? Which indication for total elbow Rheumatoid arthritis arthroplasty has the highest survivorship? What are the absolute Active infection contraindications for total elbow and charcot joint arthroplasty? What is the most common Infection complication following total elbow arthroplasty? Chapter 27 Osteoarthritis of the Upper Extremity Devan Patel

What are the symptoms Joint pain, swelling, decreased range of osteoarthritis? of motion, and tenderness What are the radiographic Osteophyte formation, sclerosis, findings of osteoarthritis? joint space narrowing, and subchondral cysts What are Heberden Palpable osteophytes of the distal nodes? interphalangeal joint in the finger Why is osteoarthritis Increased force through this joint in the DIP joints so relative to others in the hand common? What are Bouchard’s Palpable osteophytes of the proximal nodes? interphalangeal joint in the finger may occur due to osteoarthritis or rheumatoid arthritis (continued)

D. Patel, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) Laxity in what ligament is Anterior oblique ligament thought to contribute to (beak ligament) thumb CMC arthritis? What are some physical Positive CMC grind test, “Z deformity,” exam findings seen in and adduction deformity CMC arthritis? What are some Activity modification, NSADIS, conservative treatments steroid injections, and braces to CMC arthritis? What are surgical Trapezium resection, ligament treatment options for reconstruction with or without CMC arthritis? tendon interposition, osteotomy, and arthrodesis Chapter 28 Posttraumatic Arthritis: Elbow Manuel F. DaSilva

What is the physiologic ROM 0–146 extension/flexion; 71° of the elbow? of forearm pronation and 84° of forearm supination What is the elbow ROM 30–130° of flexion and extension required for most ADLs? What is the best imaging 3D reconstruction CT technology modality to assess complex deformity? How do you test for potential Elbow aspiration for cell count infection preoperatively? with differential and cultures What part of the medial Anterior bundle of the MCL collateral ligament (MCL) must be preserved during surgical release? (continued)

M. F. DaSilva, MD Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) To increase flexion doing Posterior bundle of the MCL surgical release what part of the MCL ligament must be released? Define ulnohumeral Open or arthroscopic procedure arthroplasty. that removes impinging osteophytes or loose bodies, synovectomy, and capsular release What is the clinical Lateral sided elbow pain with presentation of patients recurrent effusions with isolated radiocapitellar arthritis? What is the common location Coronoid and olecranon fossae for osteophytes that block motion? What is the most common Ulnar neuropathy nerve complication of ulnohumeral arthroplasty? What are the restrictions 10 lbs for single lift and under for patients with total elbow 2–5 lbs for repetitive lifting arthroplasty? Chapter 29 Radius and Ulnar Shaft Fractures Jeremy E. Raducha

In addition to radius/ulna Ipsilateral elbow and wrist views which radiograph tests radiographs are required in patients with forearm fractures? What type of splint is used to Sugartong initially immobilize radius/ulna diaphysis fractures? (continued)

Baratz ME. Disorders of the forearm axis. In: Wolfe SWM, editor. Green’s operative hand surgery. 7th ed. Philadelphia: Elsevier; 2017. p. 786–812. https://www-clinicalkey-com.revproxy.brown.edu/service/content/pdf/ watermarked/3-s2.0-B9781455774272000216.pdf?locale=en_US. Accessed 18 Apr 2017.Gaulke R. Diaphyseal fractures of the forearm. In: Browner B, et al., editor. Skeletal trauma: basic science, management, and reconstruction. 5th ed. Philadelphia: Elsevier-Saunders; 2015. p. 1313–47. https://www-clinicalkey-com.revproxy.brown.edu/service/content/pdf/watermarked/3-s2. 0-B9781455776283000454.pdf?locale=en_US. Accessed 23 Apr 2017.

J. E. Raducha, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What is a “both bone” fracture? Fracture of both the radius and ulna at the same level What is a “nightstick” fracture? Isolated ulnar shaft fracture What percent displacement <50% displacement and is allowed for nonoperative <10° angulation treatment in a stable ulnar shaft fracture? What is the most important Restoration of the radial bow variable in a functional outcome following radial and ulnar ORIF? What approaches are used for Volar approach of Henry and radial shaft ORIF? dorsal (Thompson) approach What are complications of Infection, synostosis, nonunion, radial/ulna ORIF? malunion, compartment syndrome, neurovascular injury, re-fracture What factor is associated with Premature plate removal, re-fracture of a surgically fixed comminuted fracture, large radius/ulna fracture? plate, persistent lucency on X-ray Chapter 30 Monteggia and Galeazzi Fracture/Dislocations Devan Patel

What is a Monteggia fracture? Proximal ulna fracture with a radial head dislocation What is the common The Bado system classification system for Type I—Proximal/middle ulna Monteggia fractures? fracture with an anterior radial head dislocation(most common) Type II—Proximal/middle ulna fracture with a posterior radial head dislocation Type III—Proximal/middle ulna fracture with a lateral radial head dislocation Type IV—Proximal/middle ulna and radius fracture with a radial head dislocation (continued)

D. Patel, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What nerve can be injured Posterior Interosseus Nerve in patients with Monteggia (PIN) injury fractures? What is the typical mechanism Fall on outstretched arm in of injury in a Monteggia hyperpronation fracture? What is a Galeazzi fracture? Distal third radius fracture with a distal radial ulnar joint dislocation What are some radiographic DRUJ widening greater than findings indicative of a DRUJ 5 mm injury? Ulnar styloid fracture Radial shortening

What are the deforming forces Brachioradialis → pulls distal in a Galeazzi fracture? fragment proximally Pronator quadratus → pronates the fragment and pulls it volarly What is the typical treatment Operative to achieve, fixation of for Galeazzi fractures? the radius and stabilization of the DRUJ What is an Essex-Lopresti A radial head fracture with an lesion? associated interosseus membrane and DRUJ disruption What are key physical exam DRUJ tenderness and DRUJ findings of a DRUJ injury? instability (piano key test) Chapter 31 Distal Radius and Ulnar Fractures Travis Blood

What test should be ordered on an Dexa scan elective basis after an elderly female has a distal radius fracture? After fixation of a distal radius fracture Distal radial-ulnar what joint needs to be checked for joint stability? What is the eponym of an extra-articular Colles fracture dorsally displaced distal radius? What is the eponym of an extra-articular Smiths fracture volarly displaced distal radius? What is the normal volar tilt of the distal 11° radius? What is the acceptable volar tilt after 5° dorsal to 20° volar reduction? (continued)

T. Blood, MD Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the acceptable articular step off? 2 mm Do you have to fix associated ulnar styloid Generally, these do fractures? not need to be fixed What soft tissue structure attaches at Triangular the base of the ulnar styloid that can be fibrocartilage injured during a distal radius fracture? complex What nerve is compressed in acute carpal Median nerve tunnel syndrome? Chapter 32 Carpal Tunnel Syndrome Andrew Paul Harris

Carpal tunnel syndrome is Median nerve caused by neuropathy of what nerve? What digits are most commonly Thumb, index, middle, and affected by carpal tunnel radial half of the ring finger syndrome? What are some conditions Diabetes, hypothyroidism, associated with a higher risk pregnancy, and obesity of developing carpal tunnel syndrome? Volar dislocation of what carpal Lunate bone is associated with acute carpal tunnel syndrome? What symptoms do patients with Night pain, pins and needles, carpal tunnel syndrome often numbness, weakness, dropping report? objects (clumsiness) (continued)

A. P. Harris, MD Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What nonsurgical treatments Wrist night splints, can be implemented to decrease corticosteroid injections symptoms? What ligament forms the roof of Transverse carpal ligament the carpal tunnel? What physical exam tests can be Durkan’s, phalen’s, reverse done to aid in the diagnosis of phalen’s, and tinel’s tests carpal tunnel syndrome? Night splints used to treat carpal Neutral tunnel syndrome should place the wrist in what position? What diagnostic test can be Electromyography and nerve performed to determine the conduction study (EMG/NCS) severity of median nerve neuropathy in carpal tunnel syndrome? Chapter 33 Cubital Tunnel Syndrome Kalpit N. Shah

What is cubital tunnel Compression of the ulnar nerve around syndrome (CuTS)? the elbow What is the most Between the two heads of the flexor common site of carpi ulnaris and its aponeurosis compression of the ulnar nerve? What are sites of Arcade of Struthers (hiatus in the compression proximal to medial intermuscular septum) the medial epicondyle? Medial intermuscular septum Osborne’s fascia What are sites of Anconeus epitrochlearis compression distal to Osborne’s ligament (medial epicondyle the medial epicondyle? to olecranon) Fascial bands of FCU Aponeurosis of FDS What are common Paresthesias of the small finger, ulnar symptoms of CuTS? half of the ring finger and ulnar dorsal hand, weak hand intrinsic muscles (continued)

K. N. Shah, MD Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA

(continued) What common hand Weakened grasp (intrinsic MCP functions are weaker in flexors), weakened pinch (weak patients with CuTS? adductor pollicis) What is the Froment’s Due to weak adductor pollicis, the FPL sign? fires to flex the thumb IP joint during key pinch (tested with a piece of paper in clinic) Provocative tests for Tinel (tapping) sign at the elbow, elbow CuTS? flexion >60s, direct pressure over elbow What advanced testing Electromyography or nerve conduction may be obtained to study confirm the diagnosis? Nonoperative options? Night splint with elbow at 45° flexion, forearm in neutral rotation Surgical options for In situ decompression, subcutaneous or management of CuTS? submuscular transposition of the ulnar nerve What superficial nerve Medial antebrachial cutaneous nerve is at risk of injury during ulnar nerve surgery? Chapter 34 Other Compressive Neuropathies Ross Feller

What are the classically Entrapment occurs beneath the superior described sites of transverse scapular ligament within suprascapular nerve the suprascapular notch, whereas entrapment and compression classically results from a compression? posterior spinoglenoid notch cyst How can one Atrophy and weakness will involve differentiate between both the supraspinatus (abduction) these two sites of and infraspinatus (external rotation) compression with with entrapment of the nerve in the physical examination? suprascapular notch, whereas only the infraspinatus will be affected with more distal compression of the suprascapular nerve (i.e., isolated external rotation weakness will result) What nerve is affected Median nerve in pronator syndrome? (continued)

R. Feller, MD The Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What are the various Supracondylar process of the humerus, sites of compression (5) ligament of Struthers, bicipital in pronator syndrome? aponeurosis (lacertus fibrosus), between ulnar and humeral heads of pronator teres, FDS aponeurotic arch What physical exam Tinel’s at the anterior forearm (not the maneuvers can be wrist as with CTS) employed to diagnosis pronator syndrome? Reproduction of symptoms with: (1) resisted elbow flexion and supination (compression at lacertus fibrosus), (2) resisted forearm pronation with elbow extended (compression between pronator heads), and (3) resisted MF flexion (compression at FDS fibrous arch) What nerve is involved Posterior interosseous nerve (PIN) in radial tunnel syndrome? What are the potential Fibrous bands anterior to radiocapitellar sites of compression joint, leach of Henry (radial recurrent in radial tunnel vessels), medial edge of ECRB, arcade syndrome? of Frohse (proximal aponeurotic/ tendinous arch of supinator, most common), distal edge of supinator What nerve is affected Ulnar nerve at the level of the wrist/ in Guyon’s canal hand. Nerve is ulnar to artery compression? Where does the nerve lie in relation to the artery? What are the Transverse carpal ligament/hypothenar boundaries of Guyon’s muscles (floor), volar carpal ligament canal? (roof), pisiform/pisohamate ligament (ulnar), hook of hamate (radial) What are the zones of Zone I is proximal to bifurcation of ulnar Guyon’s canal? nerve (mixed motor and sensory), zone II surrounds deep motor branch, and zone III surrounds superficial sensory branch Chapter 35 Kienbock’s Disease Devan Patel

What is the primary Avascular necrosis of the lunate pathophysiology that leading to eventual collapse; seen is thought to cause radiographically Kienbock’s disease? What are the stages of Stage I—Typically no radiographic Kienbock’s disease seen findings, possibly fractures seen, and radiographically? changes on MRI Stage II—Sclerosis of the lunate with possible fragmentation Stage III—Fragmentation with collapse Stage IV—Degeneration of joint surfaces surrounding the lunate causing arthritis (continued)

D. Patel, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the typical Dorsal wrist pain over the lunate history of a patient with with a history of minor or repetitive Kienbock’s disease? trauma What is the natural history Progressive pain, decrease range of of Kienbock’s disease? motion at the wrist, decreased grip strength, progressive arthritis

What are surgical options Joint pinning, joint leveling, to treat this disease? radial osteotomy, proximal row carpectomy (PRC), joint fusions, revascularization procedures, and total wrist arthroplasty What is the classic Ulnar negative variance radiographic risk factor for those with Kienbock’s disease? Chapter 36 De Quervain’s Tenosynovitis Jeremy E. Raducha

Where is the location of pain in de Dorsoradial wrist Quervain’s tenosynovitis? Which wrist compartment is First dorsal compartment of involved? the wrist Which tendons run in this Extensor pollicis brevis and compartment? abductor pollicis longus (continued)

Wolfe SWM. Tendinopathy. In: Wolfe SWM, editor. Green’s operative hand surgery. 7th ed. Philadelphia: Elsevier; 2017. p. 1904–24. https:// www-clinicalkey-com.revproxy.brown.edu/service/content/pdf/ watermarked/3-s2.0-B9781455774272000563.pdf?locale=en_US. Accessed 18 Apr 2017. Ilyas AM, Ast M, Schaffer AA, Thoder JM. de Quervain Tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007;15(12):757–64. http://journals. lww.com/jaaos/Abstract/2007/12000/de_Quervain_Tenosynovitis_of_ the_Wrist.9.aspx. Accessed 28 May 2017.

J. E. Raducha, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What is the classical physical Finkelstein test or Eichhoff exam maneuver that suggests de maneuver Quervain’s if positive? What are the nonoperative options Rest, NSAIDs, bracing, for treatment? corticosteroid injection What is the surgical option for Release of the first dorsal treatment? compartment Which nerve is most at risk during Superficial branch of the surgical intervention? radial nerve What is the common reason for Failure to decompress the failed operative intervention? extensor pollicis brevis subsheath Chapter 37 Dupuytren’s Disease Andrew Paul Harris

What cells play a primary role in Myofibroblasts Dupuytren’s disease? What two fingers are most Small and ring fingers commonly involved with Dupuytren’s disease? What physical exam test can be Palm to table test used to determine severity of Dupuytren’s disease? What type of enzyme may be Collagenase injected to treat Dupuytren’s disease? Contracture of what tissue is the Fascia cause of Dupuytren’s disease? (continued)

A. P. Harris, MD Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) Fascial bands become cords in Pretendinous cord, spiral Dupuytren’s disease. What cords cord, natatory cord, may develop? retrovascular cord

The spiral cord causes the Centrally and superficial to neurovascular bundle to displace in the A-1 pulley what direction? What is the most common surgical Fasciectomy treatment for Dupuytren’s disease? What is the most common Wound edge necrosis, complication of Dupuytren’s hematoma formation surgical excision? In Dupuytren’s disease, the Garrod’s pads (knuckle thickening of tissue on the dorsum pads) of the PIP joints is known as what? Chapter 38 Trigger Finger Andrew Paul Harris

Adult trigger finger is most often A–1 associated with what flexor tendon pulley? Treatment of trigger finger Diabetics with corticosteroid injection is less effective in what patient population? What symptoms do patients with Pain over the A–1 pulley, trigger finger often report? catching, locking of the affected digit Pediatric trigger finger may be A–1 pulley and also one treated with surgical release of slip of the flexor digitorum what structures? superficialis tendon (continued)

A. P. Harris, MD Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) Proximal to the A–1 pulley, what Palmar aponeurosis pulley other structure may contribute to (also known as Manske’s trigger finger? pulley)

What is the medical term to Stenosing tenosynovitis describe trigger finger? What are some medical conditions Gout, rheumatoid arthritis, that may contribute to trigger diabetes, trauma finger? What are two nonsurgical method Splinting, corticosteroid of treating trigger finger? injection What nerve is at risk for injury Radial digital nerve to the during surgical release of the thumb thumb A–1 pulley? A thickened nodule on the flexor Notta’s node or nodule tendon is known as what? Chapter 39 Scaphoid Fractures Andrew Paul Harris

What is the most common type of Waist fracture (middle scaphoid fracture? third) What direction is the blood flow to Retrograde the scaphoid? What scaphoid fracture is most Proximal pole scaphoid prone to nonunion or avascular fracture necrosis? Nonunion of the scaphoid may Scaphoid nonunion result in what chronic arthritic advanced collapse (SNAC condition of the wrist? wrist) Scaphoid fracture may be Lunate associated with dislocation of what carpal bone? (continued)

A. P. Harris, MD Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) If a scaphoid fracture is suspected CT scan or MRI (more but not seen on radiographs, what sensitive) additional imaging tests can be used? What physical exam findings are Tenderness with palpation associated with scaphoid fracture? of the snuff box and scaphoid tubercle What implants may be used to Headless compression surgically treat scaphoid fractures? screws, scaphoid plate What is the most common cause of Fall with hyperextension of scaphoid fracture? the wrist If a nonunion of a scaphoid is CT-scan suspected after fixation, what imaging test can be used to confirm? Chapter 40 Other Carpal Bone Fractures Devan Patel

Which patients classically Those with trauma directly to the get hook of the hamate hand such as baseball players, fractures? hockey players, and golfers Which tendons are closest to The fourth and fifth FDP tendons the hook and can cause pain when used? What radiographic view Carpal tunnel view is important to obtain with hook of the hamate fractures? What is the most common Ulnar styloid impaction on the fracture mechanism of the triquetrum during forceful wrist triquetrum? extension (continued)

D. Patel, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the most common Splint or cast immobilization treatment for triquetrum fractures? Hypothenar tenderness can Pisiform indicate a fracture of what carpal bone? What are the two types of Trapezial ridge fractures and trapezium fractures? trapezial body fractures What type of trapezium Trapezial body fractures due to fracture is commonly seen in axial loading during a fall cyclist? Chapter 41 Lunate and Perilunate Dislocations Andrew Paul Harris

What emergency condition may Acute carpal tunnel present with perilunate and lunate syndrome dislocations requiring emergency reduction and surgery? How many stages are in the Four stages Mayfield classification of perilunate/lunate dislocation? What three arcs may be injured Greater arc, lesser arc, to cause perilunate or lunate tranlunate arc dislocations? What is the most common carpal Scaphoid (known as a bone fracture associated with a transcaphoid perilunate perilunate dislocation? dislocation) (continued)

A. P. Harris, MD Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What carpal bone fractures may Radial styloid, scaphoid, be associated with perilunate or capitate, triquetrum lunate dislocations? What is the first stage of lesser arc Scapholunate ligament perilunate/lunate dislocation? disruption What is the second stage of lesser Disruption of the arc perilunate/lunate dislocation? capitolunate articulation What is the third stage of lesser Disruption of the arc perilunate/lunate dislocation lunotriquetral ligament What is the fourth stage of injury Disruption of the short required to produce a complete radiolunate ligaments lunate dislocation? causing failure of the radiolunate articulation What radiograph is best used to Lateral wrist radiograph diagnosis a perilunate or lunate dislocation? Chapter 42 First Metacarpal Base Fracture Travis Blood

What are the deforming Abductor pollicis longus, extensor forces of the Bennett pollicis longus and adductor fracture? pollicis—adduction and supination What is the volar lip of the Volar oblique ligament first metacarpal attached to in a Bennett fracture? What X-ray view is used Hyperpronated thumb view to best visualize the first metacarpal base fracture? Does the Bennett or the Bennett fracture Rolando fracture have a better prognosis?

T. Blood, MD Brown University Orthopedics, Brown University, Providence, RI, USA e-mail: [email protected]

© Springer International Publishing AG, part of Springer Nature 2018 87 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_42 Chapter 43 Skier’s or Gamekeeper’s Thumb Steven F. DeFroda

What is a skier’s thumb? Acute injury to the thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL) How does gamekeeper’s This is a chronic attenuation of thumb differ? the UCL (as opposed to an acute rupture) What tendon can get Adductor pollicus aponeurosis interposed in the ligament tear? What is the eponym for “Stener” lesion an interposed adductor tendon in a UCL injury? (continued)

S. F. DeFroda, MD, ME Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What are the operative >20° variation on varus/valgus stress indications? >35° of opening at neutral, or 30° of MCP flexion What is the mechanism of Hyperextension and abduction at the injury? MCP joint What type of imaging can Stress radiographs of the MCP joint aid in diagnosis? looking for widening

References

1. Schroeder NS, Goldfarb CA. Thumb ulnar collateral and radial collateral ligament injuries. Clin Sports Med. 2015;34(1):117–26. https://doi.org/10.1016/j.csm.2014.09.004. Chapter 44 Boxer’s Fracture Devan Patel

What are the most common Fourth and fifth metacarpals metacarpals to have a boxer’s fracture? What is the most common Interossei muscles cause apex deformity? What muscles dorsal deformity cause this deformity? What radiographs are True lateral radiographs are commonly used to measure able to depict the sagittal plane the deformity of these deformity fractures? Why are the fourth and Increased range of motion at the fifth digits able to tolerate metacarpal phalangeal joint increased angulation well? (continued)

D. Patel, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the most common Stiffness and prominence in the complication of conservative palm treatment? What are the operative Open fractures, unstable fractures, indications for this type of volar angulation greater than fracture? 10–50° depending on the digit, significant rotational deformity What are some surgical Dorsal plating, intramedullary options for fixations? fixation, lag screw fixation, and percutaneous pinning Chapter 45 Phalangeal Fractures Kalpit N. Shah

Which phalanx is Distal phalanx the most commonly fractured? What deformity is Apex volar created in proximal – Proximal fragment is flexed due to phalanx fractures? Why? interossei – Distal fragment is extended due to central slip What deformity is – Apex dorsal (if fracture is proximal created in middle to FDS insertion)—central slip phalanx fractures? Why? extends the proximal fragment and FDS flexes the distal fragment – Apex volar (if fracture is distal to FDS insertion)—FDS flexes the proximal fragment (continued)

K. N. Shah, MD Department of Orthopaedic Surgery, Warren Alpert School of Medicine of Brown University, Providence, RI, USA

(continued) What are the operative Extra-articular, <10° angulation, and indications for a 2 mm shortening proximal or middle phalanx fracture? What are the operative Nail bed injury associated with a distal indications for a distal phalanx fracture phalanx fracture? What is the most Stiffness of the affected digit common complication of phalangeal fractures? Chapter 46 Finger (Phalangeal) Dislocations Tyler S. Pidgeon

Which proximal Dorsal interphalangeal (PIP) joint dislocation type is most common? What soft tissue The volar plate and at least one structures are injured collateral ligament during a dorsal PIP joint dislocation? What deformity results Swan neck deformity from untreated dorsal PIP joint dislocations? What soft tissue The central slip and at least one structures are injured collateral ligament during a volar PIP joint dislocation? (continued)

T. S. Pidgeon, MD Department of Orthopaedic Surgery, The Warren Alpert Medical School at Brown University, Providence, RI, USA

(continued) What deformity results Boutonniere deformity from untreated volar PIP joint dislocations? How are dorsal PIP Closed reduction and buddy-taping dislocations treated? for 3–6 weeks. To reduce apply volar- directed force on the middle phalanx. Hyperextension of the middle phalanx prior to volar force may be required. Pulling traction on the finger causes the volar plate to block reduction. Open reduction with volar plate extraction may be required in irreducible dislocations How are volar PIP Closed reduction and extension dislocations treated? splinting for 6–8 weeks Describe the anatomy One proximal phalanx condyle of a rotary PIP buttholes between the central slip and dislocation. lateral band How are rotatory PIP Closed reduction is attempted dislocations reduced? with finger traction with metacarpophalangeal and PIP joints at 90° of flexion to relax the lateral band. However, open reduction is required in most cases How are dorsal distal Closed reduction and immobilization in interphalangeal (DIP) slight flexion for 2 weeks via a dorsal joint dislocations splint. Open reduction may be required treated? if volar plate is interposed Chapter 47 Metacarpal Fractures Tyler S. Pidgeon

What are the No rotational deformity. No more than acceptable parameters 2–5 mm of shortening. Maximum of for nonoperative 10–20° of angulation at the index and management of finger long fingers, 30° of angulation at the ring metacarpal shaft finger, and 40° of angulation at the small fractures? finger Why does shaft There is greater carpometacarpal (CMC) angulation joint range of motion at the small and acceptability differ ring fingers compared to the middle and between fingers? index fingers What are indications Open fractures, intra-articular fractures, for surgical rotational malalignment, displacement management of finger as listed above, multiple metacarpal metacarpal fractures? fractures, border digit fractures (continued)

T. S. Pidgeon, MD Department of Orthopaedic Surgery, The Warren Alpert Medical School at Brown University, Providence, RI, USA

(continued) How should hands In intrinsic plus position to tighten with metacarpal the collateral ligaments of the fractures be metacarpophalangeal (MCP) joint via immobilized? the cam effect of the metacarpal head; thus, preventing MCP stiffness What are surgical Closed reduction and percutaneous options of metacarpal pinning, open reduction and internal shaft fractures? fixation (ORIF) with a plate, ORIF with lag screws (minimum of two), tension band wiring, cerclage/interosseous wiring, external fixation, open intramedullary fixation What are the No rotational deformity. No more than acceptable parameters 2–5 mm of shortening. Maximum of for nonoperative 10–15° of angulation at the index and management of finger long fingers, 30–40° of angulation at the metacarpal neck ring finger, and 50–60° of angulation at fractures? the small finger Name and describe the The Jahss Technique: Flex the MCP joint reduction technique to 90° and apply dorsally directed force for metacarpal neck to the metacarpal head via the proximal fractures. phalanx while stabilizing the metacarpal shaft Chapter 48 Traumatic/Revision Finger Amputation P. Kaveh Mansuripur

When feasible, what Healing by secondary intention coverage technique (granulation) provides the best 2-point discrimination? What kind of pain do Cold intolerance patients most often complain about? The “composite graft” Children technique works best in which patients? In general, what kind of Absorbable monofilament (gut, suture should be used in chromic, etc.) the fingertips? A “V-Y” flap is useful in Transverse or dorsal oblique what kind of tissue loss? (continued)

P. Kaveh Mansuripur, MD Hand and Upper Limb Surgery, Stanford University School of Medicine, Stanford, CA, USA

© Springer International Publishing AG, part of Springer Nature 2018 99 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_48 100 P. Kaveh Mansuripur

(continued) What is the most common PIP flexion contracture complication of the thenar flap in adults? The Moberg flap is used for The thumb which digit? What is the mechanism of a In amputations proximal to the lumbrical plus finger? FDP insertion, attempt at finger flexion will tension the lumbricals and cause paradoxical extension What are the major goals Cover bone, maintain length, in treating traumatic digit maximize sensation, prevent amputations? neuromas, maximize range of motion and function When revising a traumatic Cut digital nerves under tension so amputation, how are that they retract neuromas prevented? Chapter 49 Tears of the TFCC Avi DeLano Goodman

What are the Dorsal and volar radioulnar ligaments, components of the central articular disc, meniscus homolog, TFCC? ulnar collateral ligament, ECU subsheath, ulnolunate and ulnotriquetral ligaments Which areas are Periphery (10–40%), while central is vascularized? avascular (similar to the meniscus) What are the Ulnar-sided wrist pain, especially with symptoms and turning a key (rotation), and ulnar or physical exam radial deviation findings? What are the X-ray 3-view hand, 3-view wrist—usually views needed to negative, but zero-rotation PA will show evaluate? ulnar variance (continued)

A. D. Goodman, MD Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) Which is the best MR arthrogram, with sensitivity 84% and imaging study for specificity 85% TFCC evaluation? What is the gold Wrist arthroscopy standard for diagnosis? What are the Class 1—traumatic classifications? Class 2—degenerative (Subtypes describe location) What are the surgical Arthroscopic debridement, repair, ulnar options? shaft shortening, limited ulnar head resection Chapter 50 Carpal Instability Avi DeLano Goodman

What are the broad Dissociative (within a carpal row or classifications of intracarpal) instability? Nondissociative (between carpal and intercarpal rows) and combined (both)

What are the types DISI (from scapholunate tears → scaphoid of dissociative flexes and lunate becomes dorsally instability? angulated) and VISI (volar intercalated segmental instability, from lunotriquetral tears → lunate flexes with scaphoid and becomes volarly angulated) What is the Mayfield (I–IV) classification of perilunate injuries? What are the X-ray Disruption of Gilula’s arcs findings? (continued)

A. D. Goodman, MD Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) Clinically, what is Acute carpal tunnel syndrome the acute concern with perilunate dissociation? What is the Urgent reduction and fixation, with possible surgical option carpal tunnel release for perilunate dissociation? What are the Radial styloidectomy, denervation, proximal surgical options for row carpectomy, partial or complete wrist chronic instability? fusion Chapter 51 Flexor Tendon Injuries Andrew D. Sobel

Describe the flexor In the fingers tendon “zones” Zone 1—distal to FDS insertion Zone 2 (“no man’s land”)—distal to distal palmar crease (A1 pulley), proximal to FDS insertion Zone 3—distal to carpal tunnel, proximal to distal palmar crease (A1 pulley) Zone 4—Within carpal tunnel Zone 5—Wrist and forearm proximal to carpal tunnel In the thumb Zone 1—Distal to interphalangeal joint (IP) Zone 2—Distal to A1 pulley, proximal to IP Zone 3—Thenar eminence Zone 4–5—Same as fingers (continued) A. D. Sobel, MD Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) Describe the flexor Five annular pulleys, three cruciate pulleys pulley system prevent tendon bowstringing and direct tendon gliding Odd numbered pulleys (A1, A3, A5) overlay joints (metacarpophalangeal, proximal IP, distal IP) and arise from volar plate of joints Thumb has A1, Av, oblique, A2 pulleys only Which pulleys are Fingers—A2 and A4 the most important Thumb—Oblique pulley to prevent flexor tendon bowstringing in the fingers? In the thumb? What is the Palm—FDP deep, FDS superficial orientation of Finger—FDP superficial, FDS deep flexor digitorum profundus FDS tendon splits at “campers chiasm” (FDP) and and dives deep to insert on middle flexor digitorum phalanx around FDP which continues superficialis (FDS) distal to insert on distal phalanx tendons in the palm and digit and what is the anatomic landmark where the orientation changes? What are the FDP—Flexion of distal IP joint specific functions of FDS—Flexion of proximal IP joint the FDP and FDS tendons? 51 Flexor Tendon Injuries 107

(continued) What is the Diffusion through synovial fluid created by predominate the tendon’s synovial sheath way that tendons receive nutrition? When can flexor Laceration of <60% tendon width tendon lacerations be treated nonoperatively? What is the Number of suture strands crossing repair most important site determinant of flexor tendon laceration suture repair strength? Besides crossing Simple, running epitendinous suture sutures, what can be done to improve gliding and strength of a repaired tendon? How are chronic Two-stage reconstruction flexor tendon injuries typically Stage 1—Silicone rod placement treated? Stage 2—Tendon graft interposition Chapter 52 Extensor Tendon Injuries Devan Patel

Which is the most Zone VI frequently injured zone? What is a zone I injury Injury at or distal to the DIP joint, and what is the resulting causing a mallet finger deformity deformity? What is a zone III injury Disruption of the tendon over the and what is the resulting proximal interphalangeal joint deformity? causing a central slip injury and a boutonniere deformity What zone is a “fight bite” Zone V, over the metacarpal injury and what is the phalangeal joint. Treatment is treatment? typically irrigation and debridement (continued)

D. Patel, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the Elson’s test The patient’s finger is position at 90° and what does it indicate? at the PIP, typically over the corner of a table. The patient is asked to extend against resistance. Normal: PIP extension with a flexible DIP. Abnormal: No PIP extension, with rigid DIP. Indicates central slip injury What is the classic Extension splitting nonoperative treatment of extensor injuries? What are operative Tendon repair, tendon options for extensor reconstruction, and tendon transfers tendon injuries? Nondisplaced distal radius Extensor pollicis longus rupture fractures can result in what extensor tendon injury? What is the typically EIP to EPL tendon transfer treatment for an EPL rupture? Chapter 53 Nerve Injury Ross Feller

Describe the relationship In the palm, the artery lies superficial between the digital artery (volar) to the nerve, whereas at the and nerve at the level level of the middle phalanx, this of the (1) palm and (2) relationship is reversed middle phalanx? Name the different Epineurium, perineurium, connective tissue layers endoneurium of a nerve. Describe the different Neuropraxia—No structural/anatomic three main categories of change to the nerve, best prognosis; nerve injury. Axonotmesis—Perineurium remains intact but axons within a fascicle rupture, prognosis based on degree of scarring within the fiber; Neurotmesis— Complete nerve rupture, requires repair or reconstruction (continued)

R. Feller, MD The Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the percentage The nerve can tolerated up to of nerve stretch that 10% of stretch, with 15% leading leads to neuropraxia and to neuropraxic injury and 20% or axonotmesis? greater leading to axonotmesis What is one reliable Water immersion testing: Presence of method for determining wrinkling or puckering of the finger digital nerve continuity within 4 min of submerging under in the uncooperative water at 40 °C child or the unconscious patient? What is the rate of One millimeter per day or 1 in. per growth of a peripheral month nerve following repair? What is one way to Presence of an advancing Tinel’s sign track recovery of an along the path of the injured nerve axonotmetic nerve injury using physical examination? What is the most Neuropraxia, therefore most low common nerve injury energy gunshot wounds can be resulting from low-energy managed with observation and not gunshot wounds? What is acute exploration the significance of this in terms of treatment? What are the available Epineural and grouped fascicular techniques for direct repair. Epineural repair is used most end-to-end nerve repair? commonly, with advocates believing Which technique is that the additional intraneural mostly used presently and damage involved in manipulating what is the main reason individual fascicles can lead to more proponents advocate for scarring and worse clinical results this technique? What other techniques Adhesives (e.g., Tisseel, Evicel, and are available for nerve DuraSeal), conduits (e.g., Axogen, repair other than direct vein graft), nerve grafts (autograft, end-to-end suturing? allograft, or vascularized nerve graft), end-to-side neurorraphy, nerve transfers 53 Nerve Injury 113

(continued) What is the “rule of 18”? The number of inches from the site of nerve injury to the supplied muscle plus the number of months from injury should be less than 18 inch. order for primary nerve repair to be considered. The basis of this principal lies in the fact that motor end plates will become refractory to reinnervation after about 18 months in the adult patient Chapter 54 Replantation Steven F. DeFroda

What is the most important factor Mechanism of injury when considering replantation? What is the accepted warm <6 h proximal to carpus, ischemia time for replantation? <12 h for digits What is the accepted cold <12 h proximal to carpus, ischemia time for replantation? <24 h for digits How should an amputated digit Wrapped in saline moistened be transported? gauze, in a sealed plastic bag, on ice What are the indications for • Thumb replantation? • Through palm • Multiple digits • Wrist or proximal • Any level in children • Individual digits distal to flexor digitorum superficialis insertion What is the generally accepted Bone, extensor tendon, artery, order for the repair of structures vein, flexor tendon, nerve, during replantation? skin (BEAVFTNS) (continued)

S. F. DeFroda, MD, ME Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What is the generally accepted Thumb, long, ring, small, order for replantation of multiple index digits? In a multiple digit replantation, Structure-by-structure is it preferred to repair digit-by- digit or structure-by-structure?

References

1. Beris AE, Lykissas MG, Korompilias AV, Mitsionis GI, Vekris MD, Kostas-Agnantis IP. Digit and hand replantation. Arch Orthop Trauma Surg. 2010;130(9):1141–7. https://doi.org/10.1007/ s00402-009-1021-7. Chapter 55 Rheumatoid Arthritis and Other Inflammatory Arthritides Ross Feller

What is the classic Pencil-in-cup deformity radiographic pattern of arthropathy associated with psoriatic arthritis? What is arthritis mutilans Fulminant stage of osteolysis most and what are the classic commonly observed in severe findings associated with this psoriatic arthritis; osteolysis of all disease? interphalangeal joints with digital collapse/shortening resulting in “opera glass hand” What is the characteristic Joint subluxation resembling RA radiographic appearance without radiographic articular or of systemic lupus bony destruction erythematosus (SLE)- related arthropathy? (continued)

R. Feller, MD The Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) Define swan neck and Swan neck = PIP hyperextension, boutonniere deformity? DIP flexion; Boutonniere = PIP hyperflexion, DIP extension What is the difference RA—MCP flexion and PIP in deformity in RA vs. extension (swan neck deformity), psoriatic arthritis? psoriatic arthritis—MCP hyperextension, PIP flexion (boutonniere) What are the general Methotrexate and guidelines for withholding hydroxychloroquine: do not of the various withhold; Cyclophosphamide, immunomodulating azathioprine, sulfasalazine: several medications preoperatively? days; Leflunomide: 2 weeks; DMARDs: two treatment cycles What is the common Volar and ulnar subluxation deformity affecting the MCP joints in RA? What are the options Passively correctable deformity available for correction of addressed with tendon realignment (1) passively correctable and and soft tissue reconstruction; (2) fixed MCP deformity fixed deformity addressed with related to RA? arthroplasty What is caput ulna? Chronic DRUJ involvement leads to destruction and dorsal subluxation of the ulna resulting in dorsal prominence, mechanical irritation of extensor tendons, and possible rupture What the treatment options Single—End to end repair, suture for single (small finger) and to adjacent tendon, graft; Double— double extensor tendon Suture ring finger stump to intact (ring and small finger) middle finger extensor tendon, EIP rupture in RA? transfer to small finger Chapter 56 Degenerative Arthritis of the Hand and Wrist Ross Feller

What is the ideal position of 10–20° flexion, 20 pronation, fusion of the thumb MCP? 20° abduction What is the ideal position of Index finger 20–25 flexion, fusion of the PIPJs? middle finger 30 flexion, ring finger 40 flexion, small finger 40–45 flexion What is the ideal position of Neutral to slight flexion fusion of the DIPJs? What are the initial radiographic Beaking of the radial styloid changes of SLAC wrist? with eventual radioscaphoid arthritis What are the stages of SNAC? I-radial styloid, radioscaphoid OA; II-scaphocapitate OA; III- periscaphoid OA (continued)

R. Feller, MD The Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the key factor guiding Status of the capitate the decision between performing and lunate facet articular proximal row carpectomy (PRC) cartilage versus four-corner arthrodesis (FCA) in the setting of SLAC wrist? What staging system is commonly Eaton staging used in thumb CMC OA? What is the classic deformity Metacarpal adduction with associated with end-stage thumb MCP hyperextension CMC OA? What surgical treatment options Sauve-Kapandji, Darrach, are available for management of ulnar hemiresection DRUJ OA? arthroplasty, implant arthroplasty Chapter 57 Complex Regional Pain Syndrome Ross Feller

What are the main Swelling, pain, hyperesthesia/allodynia, symptoms of CRPS? sensory abnormalities, skin changes What are the modalities Radiography (showing available for diagnosis demineralization of the limb), of CRPS other than triple phase bone scan, quantitative history and physical sweat test versus the contralateral examination? limb, thermography, and diagnostic sympathetic nerve block What changes occur There is a transition from “warm in the transition to the CRPS,” which is dominated by chronic form of CRPS? inflammatory symptoms, to “cold CRPS,” characterized by autonomic dysfunction, atrophy, contractures, dystonia, hair/nail changes (continued)

R. Feller, MD The Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What has been shown Vitamin C in some studies to decrease rates of CRPS following distal radius fracture? What are other Bisphosphonates, calcitonin, available treatment occupational therapy (graded motor options for CRPS? imagery and mirror therapy), oral steroids, acupuncture, spinal cord stimulation, sympathectomy, and in some severe cases, amputation Chapter 58 Hand Infections Ross Feller

What is the definition A paronychia is an infection between the of paronychia and nail plate and eponychial fold. A felon is felon? a suppurative infection of the pulp of the distal phalanx of a finger or thumb What is the most Pasteurella multocida (cat bite) and common organism Eikenella corrodens (human bite) responsible for infection following a cat bite and a human bite? What is Parona’s The potential space of the volar distal space? forearm between the pronator quadratus and the sheath of the FDP tendons. It is in continuity with the midpalmar space What are the three Thenar, midpalmar, and hypothenar deep spaces of the hand? (continued)

R. Feller, MD The Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What structures Midpalmar oblique septum (runs from divide the thenar palmar fascia to third metacarpal and midpalmar, shaft) and hypothenar septum (palmar and midpalmar and aponeurosis to fifth metacarpal shaft) hypothenar spaces? What is a collar An abscess of the interdigital web space. button abscess? What Fingers are held in an abducted position is the classic position of the fingers with a collar button abscess? What are Kanavel’s Four signs associated with the clinical signs? diagnosis of flexor tenosynovitis: (1) finger held in flexed posture, (2) fusiform swelling of the digit, (3) tenderness along the flexor sheath, (4) pain with passive extension of the finger What are the signs Innocuous appearing or cellulitic and symptoms of with extreme tenderness (pain out necrotizing fasciitis? of proportion) in early stages, with progression to bullae formation, soft tissue crepitus, hyper/anesthesia, and frank soft tissue necrosis accompanied by systemic sepsis as disease progresses What are the most Type I-mixed anaerobic/aerobic including common organisms non-group A strep implicated in Type II-Group A strep necrotizing fasciitis? What is the organism Clostridium species responsible for gas gangrene? Part III The Lower Extremity Chapter 59 External Snapping Hip John R. Tuttle

What anatomic structures are involved Iliotibial band snapping in external snapping hip? over greater trochanter Is external snapping hip usually painful? No Are radiographic and MRI findings Yes typically normal in this condition? What test helps diagnose a tight tensor Ober’s test fascia lata? Is nonoperative treatment successful in Yes most cases? What is the surgical treatment for IT band lengthening (or painful external snapping hip that fails windowing) nonoperative treatment? What is a potential risk specific to this Trendelenburg gait operation?

J. R. Tuttle, MD, MS Sports Medicine, Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA e-mail: [email protected]

Bibliography

1. Lewis CL. Extra-articular snapping hip: a literature review. Sports Health. 2010;2(3):186–90. https://doi. org/10.1177/1941738109357298. Chapter 60 Fractures of the Proximal Femur Viorel Raducan

What is the most common Fall from a standing height mechanism of injury for fractures of the proximal femur in the elderly? What is the most common Osteoporosis predisposing factor for fractures of the proximal femur? What is the typical clinical Shortening/external rotation and finding in fractures of the abduction proximal femur? What are the most common Nonunion and osteonecrosis orthopedic complications of fractures of the femoral neck? (continued)

V. Raducan, MD, FRCS(C) Department of Orthopaedic Surgery, Marshall University School of Medicine, Huntington, WV, USA e-mail: [email protected]

(continued) What is the preferred Surgery treatment for fractures of the proximal femur?

What is the major benefit of Decreased mortality at 1 year surgical treatment in fractures after fracture of the proximal femur? What is the most useful X-rays—hip (AP/lateral), pelvis imaging study for fractures of (AP), full length femur (AP/ the proximal femur? lateral) What is the prerequisite for Optimization of the medical optimal outcome of surgery for status and timing (within 48 h of proximal femur fractures? injury) What are the most common Internal fixation (if undisplaced) methods of surgical treatment and arthroplasty (if displaced) for fractures of the femoral neck? What is a stable Absence of fracture in the lesser intertrochanteric fracture? trochanter (the calcar) What is an unstable Presence of fracture of the intertrochanteric fracture? calcar and/or reverse obliquity fracture line (proximal medial to distal and lateral) What is the method of Dynamic hip screw or treatment for stable cephalomedullary nail (equal intertrochanteric fractures? results) What is the preferred method Cephalomedullary nail (prevents of treatment for unstable shortening and varus malunions) intertrochanteric fractures? What is the most common Screw cutout complication in surgical treatment of intertrochanteric fracture? What are the predictors of Male sex, age over 85, delay increased mortality after of surgery (>48 h), > 2 surgery for proximal femur comorbidities, ASA III–IV, fracture in the elderly? intertrochanteric pattern 60 Fractures of the Proximal Femur 131

(continued) What is the position of VARUS ± shortening ± external malunions in proximal femur rotation fractures? What are the characteristics of Low energy/transverse/no atypical femur fractures? comminution/incomplete/ biphosphosphonate use What is the most sensitive/ MRI scan specific imaging study for the diagnosis of undisplaced fractures of the proximal femur with negative X-rays? What is a subtrochanteric Fracture of the proximal femur fracture? below the lesser trochanter (with possible proximal/distal extension) What is the treatment of Surgery—internal fixation. subtrochanteric fractures? Exception—contraindication general/regional anesthesia Chapter 61 Native Hip Dislocations Viorel Raducan

What is the incidence Hip dislocations are rare injuries of hip dislocations? What are the most High energy trauma in young patients potent characteristics with 95% incidence of associated injuries of hip dislocations? How are hip Position of the head in relationship with dislocations classified? the acetabulum (anterior/posterior) and presence of associated injuries (complex—with associated injuries, simple—no associated injuries) What is the incidence 90.0% of posterior hip dislocations? (continued)

V. Raducan, MD, FRCS(C) Department of Orthopaedic Surgery, Marshall University School of Medicine, Huntington, WV, USA e-mail: [email protected]

(continued) What is the Dashboard injury (impact on the knee mechanism of with the hip adducted and internally posterior hip rotated) dislocation? What are the Fractures of the posterior wall of the associated injuries acetabulum, femoral head and neck, in posterior hip injury to the sciatic nerve, fractures dislocations? around the knee (25%) What is the clinical Leg shortened, hip flexed, adducted, and presentation in internally rotated posterior? What is the EMERGENT REDUCTION—within determinant 6 h of injury/presentation prognostic factor in treatment of hip dislocation? What are the imaging X-rays—AP pelvis and CT scan studies? What are the Postreduction, complex dislocations indications for CT scan in hip dislocations? What is the Impact on the leg in abduction mechanism of anterior hip dislocations? What is the SUPERIOR (impact on the leg classification in abduction and extension) and of anterior hip INFERIOR (obturator)—impact on dislocation? the leg in hip flexion, abduction, and external rotation What are the Irreducible dislocation, nonconcentric indications of open reduction, intra-articular body, complex reduction in hip dislocations dislocation? 61 Native Hip Dislocations 135

(continued) What are the Femoral head impaction and chondral associated injuries injuries in anterior hip dislocations? What are the Osteonecrosis of the femoral head complications of hip (5–40%), posttraumatic arthritis (20%), dislocations? sciatic nerve palsy (8–20%), recurrent dislocation (<2%) How can hip The position of the hip (internal dislocations be rotation—POSTERIOR, external differentiated rotation—ANTERIOR) clinically? Chapter 62 Hip Osteoarthritis Stephen Marcaccio

Define osteoarthritis. A pathologic, non-reversible condition characterized by destruction of articular cartilage Describe a physical Overweight body habitus, potential exam for a patient with leg length discrepancy, lack of full hip OA. extension or flexion in passive ROM, catching/clicking Name four radiographic 1. Subchondral cysts findings with OA. 2. Subchondral sclerosis 3. Osteophyte formation 4. Joint space narrowing What is the conservative Physical therapy, scheduled anti- treatment for hip OA? inflammatories, weight loss (continued)

S. Marcaccio, MD Department of Orthopaedic Surgery, Rhode Island Hospital, Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the eponym Smith-Petersen for the direct anterior approach to the hip? What is the eponym for Southern/Moore the posterior approach to the hip? What is the interval Superficial: TFL/Sartorius for the direct anterior Deep: Rectus femoris/gluteus medius approach to the hip? What is a major danger Lateral femoral cutaneous nerve in the direct anterior approach to the hip? What is a major danger Sciatic nerve in the direct posterior approach to the hip? What is the classic Flexion, adduction, and internal position of posterior hip rotation dislocations? What is the classic Extension, abduction, and external position for anterior rotation dislocation of the hip? Chapter 63 Osteonecrosis Stephen Marcaccio

Define avascular An orthopedic phenomenon necrosis. characterized by decreased vascular perfusion to the bones supporting the hip joint resulting in bone destruction and joint breakdown List three direct causes 1. Irradiation of AVN. 2. Trauma 3. Hematologic disease (leukemia) List three indirect 1. Alcoholism causes of AVN. 2. Hypercoaguable state 3. Chronic steroid use 4. Idiopathic (continued)

S. Marcaccio, MD Department of Orthopaedic Surgery, Rhode Island Hospital, Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the name The Steinberg Classification (modified of the classification Ficat) system for AVN? What is the most MRI sensitive and specific imaging test for detecting AVN? What is the most Bisphosphonates common method of conservative management for AVN? List three operative 1. Core decompression with bone interventions for grafting management of AVN. 2. Rotational osteotomy 3. Total hip resurfacing Chapter 64 Total Hip Arthroplasty Nicholas Lemme and Alexandre Boulos

What are the four most Posterior/posterolateral; direct popular surgical approaches lateral, anterolateral, direct anterior to the hip? What are the four 1. Acetabular shell components that make up a 2. Acetabular lining total hip arthroplasty? 3. Femoral head 4. Distal stem (continued)

N. Lemme, MD (*) · A. Boulos, MD Department of Orthopaedics, Brown University, Providence, RI, USA e-mail: [email protected]; [email protected]

© Springer International Publishing AG, part of Springer Nature 2018 141 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_64 142 N. Lemme and A. Boulos

(continued) What are the intervals for Gluteus maximus (inferior gluteal the posterior/posterolateral nerve) and gluteus medius/tensor approach to the hip and fascia lata (superior gluteal nerve) what are the structures at Structures at risk are sciatic nerve, risk? inferior gluteal artery, and medial femoral circumflex artery What are the superficial Superficial: Sartorius (femoral and deep intervals for the nerve) and tensor fasciae lata direct anterior approach to (superior gluteal nerve) the hip and what are the Deep: Gluteus medius (superior structures at risk? gluteal nerve) and rectus femoris (femoral nerve) Structures at risk: Lateral femoral cutaneous nerve, ascending branch of lateral femoral circumflex What is the recommended 30–50° Abduction and 5–25° placement of the cup in the anteversion acetabulum? What are the two methods 1. Cement fixation of prosthetic fixation for a (polymethylmethacrylate) THA? 2. Bone in-growth fixation (porous) What is the classification Vancouver classification system used for post-op periprosthetic femur fractures? What is the most common Peroneal branch of sciatic nerve, nerve injury seen in THA? because it is closest to the acetabulum What are the common 1. Placing a femoral component that causes of intraoperative is too large periprosthetic femur 2. Aggressive rasping during bone fractures? preparation 3. Rapid impaction of femoral component What are risk factors 1. Poor bone quality for post-operative 2. Cementless prostheses periprosthetic femur 3. Compromised bone stock fractures? 4. History of revisions 64 Total Hip Arthroplasty 143

What is the most common 75–90% occur posteriorly direction of hip dislocation following THA? Which hip positions put one Hip flexion and internal rotation at most risk for a posterior dislocation following a posterior approach? Which hip positions put one Hip extension and external rotation at most risk for an anterior dislocation following an anterior approach? What are the surgical- 1. Soft tissue tension related factors that increase 2. Component position the risk of dislocation 3. Impingement following THA? 4. Head size 5. Acetabular lining profile What can be done to 1 time dose of radiation or prevent heterotopic indomethacin ossification in a predisposed patient? How can a periprosthetic Replace implant with longer stem femur fracture with an that passes the fracture site unstable implant be treated? Why is it important for a 1. Allows for balancing of soft tissue surgeon to replicate the resulting in improved hip stability offset when performing a 2. Prevents leg length discrepancies THA? Which is the safest zone Posterior-superior zone for the placement of Structures: superior gluteal acetabular screws and what nerve/vessels and the sciatic neurovascular structures are nerve at risk in this zone? Chapter 65 Femoral Shaft Fractures James Levins

When evaluating and treating Ipsilateral femoral neck a high-energy femoral shaft fracture (up to 9% fracture, what other type of co-incidence with shaft femur fracture in the ipsilateral fractures, obtain a CT scan leg must you have a high with fine cuts through the suspicion for? femoral neck) [1] What four aspects of the Length, rotation, femoral neck operative extremity do you need (for fracture), knee exam for to check after fixing a femoral ligamentous injury shaft fracture? How much blood can potentially 1–1.5 L be lost in the thigh from a femoral shaft fracture? (continued)

J. Levins, MD Orthopaedic Surgery, Brown University, Providence, RI, USA

(continued) In a mid-shaft femur fracture, Varus—from the gluteal what position does the proximal muscles and external rotators femoral segment usually rest which abduct the proximal relative to the distal segment, segment (the adductor mass and why? will translate the distal segment medially) Flexed—from the psoas which flexes the proximal segment (the gastrocnemius inserts above knee on posterior femoral condyles and extends the distal segment relative to the proximal) What two approaches may be Anterograde (piriformis—or used for intramedullary nailing trochanteric-entry nail) or of a femoral shaft fracture? retrograde Is there a difference in union No rate between anterograde and retrograde nailing of a mid-shaft femur fracture? If placing a tibial traction pin for Laterally, to avoid injury to a femur fracture, which side of the common peroneal nerve the tibia should you start your incision and why? In an unstable poly-traumatized To avoid further hypotension patient who is taken emergently by minimizing time under to the OR with neurosurgery for anesthesia, limiting blood loss a closed head injury and noted and lowering the risk of fat to have a femoral shaft fracture, emboli, i.e., damage control why would it be prudent to orthopedics perform external fixation instead of intramedullary nailing?

Reference

1. Tornetta P, Kin MSH, Creevy WR. Diagnosis of femoral neck fractures in patients with a femoral shaft fracture. J Bone Joint Surg. 2007;89A:39–43. Chapter 66 Ligamentous Knee Injury James Levins

Classically, what injuries compose the Anterior cruciate “unhappy triad” or “terrible triad” ligament (ACL), medial injury to the knee? collateral ligament (MCL), medial meniscus injury Which meniscus (medial or lateral) is Lateral meniscus commonly injured in an acute ACL rupture? What is the reason for the limited Intra-articular structures healing potential of the cruciate have poor blood supply ligaments relative to the collateral relative to the rich ligaments? extra-articular supply What motion does the ACL primarily Anterior tibial prevent? translation (continued)

J. Levins, MD Department of Orthopaedic Surgery, Brown University, Providence, RI, USA

(continued) What knee injury is commonly seen Posterior cruciate in a dashboard-type injury where a ligament (PCL) tear patient sustains a posterior acetabular wall fracture? When performing ACL reconstruction, Vertically oriented ACL what technical error is associated with graft, often resulting early ACL failure? from a femoral tunnel placed too anteriorly A patient has a multi-ligamentous Pulse exam, ankle- knee injury after a motorcycle accident, brachial index (ABI), suspicious for a knee dislocation that CT angiogram if ABI was reduced in the field. What studies <0.9 (due to the risk of would you want to obtain urgently? popliteal artery injury) Chapter 67 Meniscal Tear Jonathan Hodax

What are the three Central: The “white-white,” or avascular zones of the meniscus? zone Middle: The “red-white,” or partially vascularized zone Peripheral: The “red-red,” or vascularized zone What meniscus tears Only those in the vascular zones of the can be repaired? meniscus (peripheral tears) What is the “gold Vertical mattress sutures in an “inside standard” technique for out” technique (meaning the suture meniscal repair? needle is passed from within the joint to outside the joint) (continued)

J. Hodax, MD, MS Department of Orthopedics, Rhode Island Hospital, Providence, RI, USA

(continued) In what population is Older patients with degenerative tears the medial meniscus more likely to be injured? In what population is Younger patients with an acute injury, the lateral meniscus especially together with an ACL tear more likely to be injured? What is the effect of Increased joint contact pressure, removing or debriding decreased joint stability, and an overall some or all of the faster progression to arthritis meniscus? Chapter 68 Extensor Mechanism Injuries of the Knee Jonathan Hodax

What are the components of the The quadriceps, the extensor mechanism? quadriceps tendon, the patella, the patellar tendon, and the tibial tubercle In what age group are each of Tibial tubercle: Patients the components of the extensor with open physes (pediatric mechanism injured? patients) Patellar tendon: Patients <40 years old Patellar tendon: Patients <40 years old Quad tendon: Patients >40 years old Patellar fractures: Any age (continued)

J. Hodax, MD, MS Department of Orthopedics, Rhode Island Hospital, Providence, RI, USA

(continued) What physical exam finding Inability to straight leg is an indication for operative raise, or an “extensor lag” management in suspected quad of 30° tendon rupture, patellar tendon rupture, or patellar fracture? What allows some patients with An intact medial and complete transverse patella lateral retinaculum fractures to still perform a straight leg raise? What kind of suture is typically used A running locking stitch, on the quad tendon and the patellar typically a “Krackow” tendon to prevent suture cut-out? What are the ways tendon can be Suture can be passed repaired back to the patella? through bone tunnels and tied or can be fixed to the bone using suture anchors Chapter 69 Lower Extremity Tibia and Fibula Shaft Fractures Tyler S. Pidgeon

When treated with Less than 10° of flexion/extension closed reduction, what and 5° of varus/valgus. There should are the acceptable be 50% cortical apposition, less than parameters for 1 cm of shortening, and less than 10° of angulation in the rotational malalignment sagittal and coronal planes as well as rotation and length in tibia shaft fractures? Proximal third Procurvatum (apex anterior) and tibia shaft fractures valgus classically fall into what deformity during intramedullary nailing? (continued)

T. S. Pidgeon, MD Department of Orthopaedic Surgery, The Warren Alpert Medical School at Brown University, Providence, RI, USA

(continued) To avoid deformity Blocking screws (posterior and lateral during intramedullary to avoid procurvatum and valgus, nailing of proximal third respectively), unicortical plating, tibia shaft fractures, and semi-extended or suprapatellar name three techniques approaches that may be used. What is the most Anterior knee pain (>50% of cases) common complication of intramedullary nailing of tibia shaft fractures? Describe the Gustilo- Type I: Wound <1 cm; minimal Anderson classification periosteal stripping. Type II: Wound for open tibia fractures. 1–10 cm; mild to moderate periosteal stripping. Type III A: Wound >10 cm; substantial periosteal stripping and soft tissue injury; no flap required. Type III B: Substantial periosteal stripping and soft tissue injury; flap required due to inadequate soft tissue coverage. Type III C: Substantial soft tissue injury with vascular injury requiring repair In open tibia fractures Early administration of antibiotics what is the most important intervention in reducing infection? According to the LEAP Severity of soft tissue injury study, what is the most critical predictor for amputation in open tibia fractures? In patients with tibia Compartment pressure monitoring fractures, what is demonstrating a compartment pressure the most sensitive within 30 mmHg of the patient’s pre- diagnostic test (other operative diastolic blood pressure than physical exam) for the diagnosis of compartment syndrome? 69 Lower Extremity Tibia and Fibula Shaft Fractures 155

What are the Decreased time to union and decreased advantages of time to weight bearing intramedullary nailing compared to closed reduction and casting of tibia shaft fractures? How does the time to Time to union is equivalent between union compare between these methods treatment of tibia shaft fractures with intramedullary nailing vs. plating? Chapter 70 Distal Femoral Fractures Viorel Raducan

What is the definition of a Fractures in the area 5 cm’s distal femoral fracture? proximal to the distal femoral joint line What is the age distribution Bimodal—young and elderly of distal femoral fractures? What is the mechanism High energy trauma of injury of distal femoral fractures in the young population? What is the mechanism Low energy trauma—fall from of injury in the elderly standing height population? How are distal femoral Extraarticular/intraarticular/ fractures classified? periprosthetic (continued)

V. Raducan, MD, FRCS(C) Department of Orthopaedic Surgery, Marshall University School of Medicine, Huntington, WV, USA e-mail: [email protected]

(continued) What is the typical Extension (gastrocnemius), displacement of distal shortening (hamstrings), and varum femoral fractures (adductors) What structure is at risk in Popliteal artery—emphasis on (displaced) distal femoral vascular exam, presence of distal fractures and all injuries pulses around the knee? What is the imaging study X-rays—knee (AP/lateral/obliques), of choice for fractures of full length femur the distal femur? What is a Hoffa fracture? Fracture of the lateral condyle of the femur in the coronal plane What is the indication for Intraarticular extension, CT scan in distal femur preoperative planning fractures? What is the indication Absence of distal pulses especially for angiography in distal if no recovery after limb alignment femoral fractures? (in line traction) What is the preferred Surgery—open reduction and treatment for distal femoral internal fixation fractures? When can nonoperative Prohibitive surgical risk. Relative treatment be considered indication—non displaced fractures in fractures of the distal femur? What are the implants Fixed angle devices and retrograde of choice for the surgical intramedullary nails treatment of distal femoral fractures? What are the goals of Re-establish the anatomical knee surgery in distal femoral axis and an anatomical joint fractures? line with stable internal fixation allowing early active range of motion What are the complications Malunion, varum nonunion (19%), after treatment of distal and symptomatic hardware femoral fractures? Chapter 71 Patellar Fractures Brian H. Cohen

What is the extensor Quadriceps muscle, quadriceps tendon, mechanism of the knee medial and lateral retinaculum, made up of? What patellofemoral and patellotibial function does the ligaments, patella, patellar tendon and extensor mechanism tibial tubercle, extension of the knee have? What are the two main Lateral and medial facets, a vertical facets of the patella? ridge divides the larger lateral facet Which is larger? What (about 2/3 the area) from the smaller is unique about the medial facet, the patella has the thickest articular cartilage? articular cartilage in the body What is the blood The geniculate arteries from an supply to the patella? extraosseous arterial ring which also give the intraosseous blood supply (continued)

B. H. Cohen, MD Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What is the mechanism Usually, a direct blow or fall onto of injury? patella or indirect eccentric contraction, more common in patient <40 years old (Quadtriceps tendon tears more common in patients >40 years old) What physical exam Knee extension of the knee. Straight leg finding should you raise test. If able to extend knee, then test? If intact what the patellar retinaculum is intact could be the reason for this? If there is a large Arthrocentesis with aspiration of the hemarthrosis and it hemarthrosis and injection of lidocaine, is difficult to exam then reexamine the knee for extension patient due to pain what can you do? What can be mistaken A bipartite patella which is a failure of for a patella fracture ossification centers to fuse. It commonly on X-ray? What is bilateral (50%) and is located in it? Where is it most the superior lateral quadrant of the commonly located? patella What are the types of Transverse, pole (superior and inferior) patella fractures? or sleeve (inferior pole in childern), vertical, marginal, osteochondral, comminuted (stellate) What are indications Intact extensor mechanism (able to for nonoperative straight leg raise), nondisplaced or treatment? What is the minimally displaced fractures, vertical treatment? fracture, early weight bearing in extension in cylinder cast or locked hinged knee brace, begin early in range of motion in 2–3 weeks What are surgical Open fractures, intraarticular step off of indications for patella 2 mm or more, and the inability of the fractures? patient to extend knee actively What are some surgical Tension-band wiring, lag screw fixation, options of fixation? cerclage, cannulated lag screw with tension band, partial patellectomy, and total patellectomy Chapter 72 Knee Tendon Rupture (Patellar and Quadriceps Tendons) John R. Tuttle

What age and gender is Males younger than 40 most likely to be affected by patellar tendon rupture? What exam finding would Loss of active knee extension or you expect with a complete extensor lag patellar tendon rupture? What radiographic findings Patella alta, MRI might you expect and what imaging modality is the most sensitive to confirm the diagnosis? What is the preferred Primary repair treatment for acute, complete patellar tendon tears? (continued)

J. R. Tuttle, MD, MS Sports Medicine, Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA e-mail: [email protected]

(continued) What do you do if the tendon Auto or allograft tendon is not repairable? reconstruction What age and gender is Males over 40 more likely to be affected by quadriceps tendon rupture? What are some risk factors Renal failure, diabetes, RA, for quad tendon rupture? hyperparathyroidism, connective tissue disorders, steroids, cortisone injections What radiographic finding Patella baja would you expect with quad tendon rupture? What is the preferred Primary repair, chronic injuries treatment for acute or may require tendon lengthening chronic quad tendon rupture? (V-Y) or graft augmentation What are some common Knee stiffness, strength deficit complications following quad (nearly half of patients), inability tendon repair? to return to sports (about half of patients)

Bibliography

1. Brooks P. Extensor mechanism ruptures. Orthopedics. 2009;32(9). Chapter 73 Patellar Dislocation Steven F. DeFroda

What ligament is often Medial patellafemoral ligament injured in patellar (MPFL) [2] dislocation? What are risk Hyperlaxity factors for patellar Trochlear dysplasia dislocation? [1] Lateral condyle hypoplasia High Q angle Prior instability event Excessive lateral patellar tilt Increased femoral anteversion Genu valgum External tibial torsion What is “miserable Combination of genu valgum, excessive malalignment femoral anteversion, and external tibial syndrome”? torsion. All contribute to high Q angle (continued)

S. F. DeFroda, MD, ME Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What type of bony Avulsion fracture of medial patellar injury is associated facet and/or impaction fracture of with patellar lateral femoral condyle [2] dislocation? What is the best way to Sunrise view radiograph assess patellar tilt? What is the TT-TG Distance between lines drawn distance? perpendicular to posterior tibial cortex at the level of the tibial tubercle and trochlear groove on axial CT/MRI cuts What is an abnormal Greater than 15–20 mm TT-TG distance?

References

1. Khan N, Fithian D, Nomura E. In: Sanchis-Alfonso V, editor. Anterior knee pain and patellar Inestability. London: Springer; 2011. https://doi.org/10.1007/978-0-85729-507-1. 2. DeFroda SF, Hodax JD, Cruz AI. Patellar instability. J Pediatr. 2016;173:258–258.e1. https://doi.org/10.1016/j.jpeds.2016.03.025. 3. Waterman BR, Belmont PJ, Owens BD. Patellar dislocation in the United States: role of sex, age, race, and athletic participation. J Knee Surg. http://www.ncbi.nlm.nih.gov/pubmed/22624248. Published 2012. Accessed 27 Nov. 2015. 4. Fithian DC. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004;32(5):1114–21. https://doi. org/10.1177/0363546503260788. 5. Chotel F, Bérard J, Raux S. Patellar instability in children and adolescents. Orthop Traumatol Surg Res. 2014;100(1 S):S125–37. https://doi.org/10.1016/j.otsr.2013.06.014. Chapter 74 Total Knee Arthroplasty Alexandre Boulos and Nicholas Lemme

Describe the X-ray 1. Joint space narrowing findings of an arthritic 2. Osteophytes knee 3. Subchondral sclerosis 4. Subchondral cyst What is the difference The anatomic axis runs from the top of between the anatomic the greater trochanter straight through and mechanical axis of the center of the femur and down to the the femur? middle of the ankle. The mechanical axis extends from the center of the femoral head through the medial tibial spine and down to the center of the ankle joint (continued)

A. Boulos, MD (*) · N. Lemme, MD Department of Orthopedics, Brown University, Providence, RI, USA e-mail: [email protected]; [email protected]

© Springer International Publishing AG, part of Springer Nature 2018 165 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_74 166 A. Boulos and N. Lemme

(continued) What is the normal The anatomic axis is normally 6° of position of the valgus from the mechanical axis. In most anatomic axis relative people with OA, this angle will be in to the mechanical relative varus axis? How do those change in osteoarthritis? What are the most 1. Medial parapatellar approach common approaches 2. Midvastus for simple primary 3.Subvastus TKA? 4. Minimally invasive What is the interval The interval lies between the rectus for the medial femoris muscle and the vastus medialis parapatellar approach to the knee? What structure can The popliteus muscle be identified in the posterior aspect of the lateral compartment of the knee? Which structure is Superior lateral genicular artery responsible for blood supply to the patella after TKA with a medial approach? What are the two 1. Measured resection most commonly 2. Gap balancing (soft-tissue tension used techniques for balancing) balancing the flexion and extension gaps during TKA? What is the preferred External rotation of the femoral and rotation of the femoral tibial components decreases the Q angle and tibial components and the strain on the lateral retinaculum. and why? This helps to prevent patella maltracking and dislocation postoperatively 74 Total Knee Arthroplasty 167

What are the five most 1. Aseptic loosening—MCC after 2 years common causes of 2. Septic failure—MCC within 2 years failure in TKA? 3. Ligamentous instability/flexor mechanism disruption 4. Periprosthetic fracture 5. Arthrofibrosis How do the following 1. Changing the distal femur will only affect the flexion/ change the extension gap extension gaps, 2. Changing the femoral component size respectively: will only change the flexion gap 1. Changing the 3. Any chance to the proximal tibia distal femur? or the insert will change both the 2. Changing the extension and flexion gaps femoral component size? 3. Changing the proximal tibia or changing the polyethylene insert? What neurovascular 1. Check DP and PT pulse structures should be 2. Check function of deep and superficial assessed after TKA? peroneal nerves What are risk factors 1. Poor bone quality for periprosthetic 2. Mechanical stress-risers fractures after TKA? 3. Neurological disorders What classification Lewis and Rorabeck for distal femur system is used for fractures periprosthetic fractures Felix for tibial fractures of the knee? A patient with history 1. CBC, ESR, CRP, knee aspiration with of TKA presents cell count and culture with knee pain and 2. X-rays of the joint instability. What studies should you order? (continued) 168 A. Boulos and N. Lemme

(continued) What is the difference Prosthetics used in TKA can be between a constrained broadly classified as constrained or and unconstrained unconstrained implant? Constraint refers the valgus and varus stability provided by the implant. An unconstrained implant does not offer this stability and instead relies on the native MCL and LCL for this function What are the two Constrained implants can either be types of constrained hinged or unhinged. The hinge refers implants and what are to an axle connecting the tibial and the differences? femoral components. A nonhinged design may be used for isolated LCL or MCL instability while a hinged design is preferred for global ligamentous instability or hyperextension instability What are the two Cruciate retaining and posterior types of unconstrained stabilizing implants? What is a cruciate Cruciate retaining implants rely on an retaining implant intact PCL for posterior stabilization. and what are the They are usually used for patients with indications for its use? stable knees and no significant valgus What are pros and or varus deformities. Patients have cons? improved proprioception and do not experience impingement. However, a rupture PCL may lead to instability and a need for revision What is a posterior Posterior stabilizing implants have a stabilizing implant constraint that provides the stability and what are the of the PCL, which is removed during indications for its use? surgery. It is preferred some patients What are pros and with inflammatory arthritis. Patients cons? have better ROM and no risk of PCL rupture. Disadvantages include the possibility of impingement, dislocation, and patellar clunk syndrome Chapter 75 Patellofemoral Pain Syndrome Steven F. DeFroda

What is the purpose of the Acts as a fulcrum to transmit forces patella? across the knee How much force does Approximately 5–10 times body the patellofemoral joint weight experience? What is the first- Symptomatic management with line management of NSAIDs, muscle strengthening patellofemoral syndrome? around the knee, and weight loss What is the typical Chondromalacia of the pathology involved? patellofemoral joint What is the outerbridge Type 1: softening classification of Type 2: fissuring chondromalacia? Type 3: crabmeat changes with no subchondral bone exposed Type 4: subchondral bone exposed

S. F. DeFroda, MD, ME Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

Reference

1. Crossley KM, Callaghan MJ, van Linschoten R. Patellofemoral pain. BMJ. 2015;351:h3939. http://www.ncbi.nlm.nih.gov/ pubmed/26537829. Accessed 9 May 2017. Chapter 76 IT Band Syndrome John R. Tuttle

What anatomic structures are IT band rubbing over lateral involved in IT band syndrome femoral condyle, pain is over and where does it hurt? lateral femoral condyle What limb alignment issue Genu varum or recurvatum is associated with IT band syndrome? What is the origin, insertion, Continuation of tensor fascia and innervation of the IT lata, Gerdy’s tubercle, superior band? gluteal nerve (L1–3) What is the main treatment IT band stretching method? Do the majority of patients Yes improve without surgery? What surgical intervention is IT band windowing over lateral appropriate if nonoperative femoral epicondyle, IT band treatment fails? lengthening in refractory cases

J. R. Tuttle, MD, MS Sports Medicine, Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA e-mail: [email protected]

Bibliography 1. Beals C, Flanigan D. A review of treatments for iliotibial band syndrome in the athletic population. J Sports Med. 2013;2013:367169. https://doi.org/10.1155/2013/367169. Chapter 77 Lower Extremity Tibial Plateau Fractures Tyler S. Pidgeon

Recite the Schatzker Type I: Lateral Split; Type II: classification for tibial plateau Lateral Split/Depressed; Type fractures III: Lateral Depressed; Type IV: Medial; Type V: Bicondylar; Type VI: Metaphysis/Diaphysis Dissociation What severe knee injury is a Knee dislocation medial tibial plateau fracture said to be equivalent to? What test helps to rule out Ankle-Brachial Index (ABI). a vascular injury in a patient ABI of <0.9 has high sensitivity with a tibial plateau fracture? and specificity for diagnosis of a vascular injury and warrants further workup (continued)

T. S. Pidgeon, MD Department of Orthopaedic Surgery, The Warren Alpert Medical School at Brown University, Providence, RI, USA

(continued) After ORIF of tibial plateau Joint alignment and stability fractures what is the best indicator of long-term outcomes? What temporizing measure Knee-spanning external fixation is indicated in a patient with a severely displaced tibial plateau fracture with substantial shortening, angulation, and/or impaction? Patients with tibial plateau Compartment syndrome fractures are at risk for development of what condition considered to be an orthopedic emergency? What imaging modality is most CT scan useful in preoperative planning for tibial plateau fractures? Which meniscus is most Lateral meniscus commonly torn in patients with tibial plateau fractures? Bicondylar tibial plateau Lateral and medial plating fractures undergoing ORIF should be considered for what type of fixation? Describe the shape and Lateral: Convex and proximal; position of the lateral and Medial: Concave and distal medial tibial plateau Chapter 78 Stress Fracture John R. Tuttle

When overuse results in Fatigue fracture (a subtype of trabecular microfractures from stress fracture) repetitive pressure applied to a normal bone, it is called what? When overuse results in Insufficiency fracture (a trabecular microfractures from subtype of stress fracture) repetitive pressure applied to an abnormal bone, it is called what? Stress fracture pain increases Activity, rest with ____ and improves with ____ What is the most sensitive and MRI specific diagnostic test for stress fractures? (continued)

J. R. Tuttle, MD, MS Sports Medicine, Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA e-mail: [email protected]

(continued) Should all stress fractures be No (e.g., tension-sided femoral treated without surgery, at least neck) at first? What athlete is at higher risk for Rowers stress fractures in ribs 4–9? Bisphosphonate medication has Subtrochanteric femur been linked to what anatomic fracture site of stress fracture? What three conditions must you Amenorrhea, eating disorder, address in a female athlete with a osteoporosis (female triad) stress fracture? What is the most common lower Tibia, accounts for half of all extremity stress fracture site and stress fractures how common is it among all stress fractures? What is the second most Metatarsals (most common: common site for stress fractures second and third), military and which populations tend to be recruits (marching), and ballet affected by them? dancers (en pointe)

Bibliography

1. Astur DC, Zanatta F, Arliani GG, Moraes ER, Pochini A de C, Ejnisman B. Stress fractures: definition, diagnosis and treatment. Rev Bras Ortop. 2016;51(1):3–10. https://doi.org/10.1016/j. rboe.2015.12.008. Chapter 79 Metatarsalgia Stephen Marcaccio

Define metatarsalgia. Symptom of pain experienced in the ball of the foot List three causes of Traumatic (MTP dislocations) metatarsalgia. Acquired (hallux valgus) Infectious (synovitis/ osteomyelitis) Define Morton’s neuroma. Compressive neuropathy of the interdigital nerve Where is Morton’s neuroma Commonly involves the second/ most commonly located? third interdigital nerve between the metatarsal heads (continued)

S. Marcaccio, MD Department of Orthopaedic Surgery, Rhode Island Hospital, Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What physical exam findings Positive web space are common with Morton’s compression test neuroma? Mulder’s click (felt when squeezing metatarsals together) What is the technique for Cut the interdigital nerve as far operative management of proximal as possible to prevent Morton’s neuroma? recurrence Which metatarsal is the most The second metatarsal common involved with stress fractures? What is the best radiographic Acute: MRI method to detect? Acute Chronic: X-ray osteomyelitis or chronic? Chapter 80 Hallux Valgus Rishin J. Kadakia and Jason T. Bariteau

Hallux Valgus Questions and Answers What is another common name Bunion deformity for hallux valgus? What two types of hallux valgus Adult and juvenile exist? How do you describe the great Hallux is in valgus and toe in hallux valgus? pronated What symptoms are common Pain over medial prominence with hallux valgus with shoe wear, pain with range of motion of first toe What is the first-line treatment Shoe modification (wide toe for hallux valgus? box shoe), toe spacers, and orthotics (continued)

R. J. Kadakia, MD (*) · J. T. Bariteau, MD Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA e-mail: [email protected]

© Springer International Publishing AG, part of Springer Nature 2018 179 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_80 180 R. J. Kadakia and J. T. Bariteau

(continued) Hallux Valgus Questions and Answers What are some differences Juvenile hallux valgus is often between adult hallux valgus and bilateral, familial, usually juvenile hallux valgus? not painful (more cosmetic concerns) The sesamoids are found within Flexor hallucis brevis which muscle’s tendons? What is the hallux valgus angle Angle between a line through (HVA)? the long axis of the first metatarsal and a ling through the long axis of the proximal phalanx What is the intermetatarsal angle Angle between the long axis (IMA)? of the first metatarsal and the second metatarsal What is considered normal for Less than or equal to 15° the HVA? What is considered normal for Less than or equal to 9° the IMA? What are the names of some of Chevron, Mitchell the distally based osteotomies of the first metatarsal commonly used in correction of hallux valgus? What are the names of the Scarf, Ludloff proximally based osteotomies of the first metatarsal commonly used in correction of hallux valgus? What is the indication for a First TMTJ instability, Lapidis Lapidus procedure? is a fusion of the first TMTJ Chapter 81 Heel Pain Stephen Marcaccio

What significant anatomical Achilles tendon, foot/toe flexor tendons/nerves are located bundle, tibial neurovascular around the heel? bundle, plantar fascia From a lateral view, what is Anterior to posterior: tibialis the anatomic relationship of posterior, FDL, nerve, then the tibialis posterior, FDL, and HFL (“Tom, Dick, and FHL? Nervous Harry”) What are the differences in Studies have shown that outcomes between operative there are minimal long-term and nonoperative management differences between the two of Achilles tendon ruptures? methods of management What is the name of the stitch The Krackow stitch used for Achilles tendon repair? What is the most common type Calcaneus fracture of tarsal fracture? (continued)

S. Marcaccio, MD Department of Orthopaedic Surgery, Rhode Island Hospital, Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What are the names of the two The Essex-Lopresti and classification systems for intra- sanders classification systems articular calcaneus fractures? What is a normal Bohler angle 40° measurement? What is a normal angle of 130–145° Gissane? What is the value of MRI in the Can be used to diagnose diagnosis of calcaneus fractures? calcaneal stress fractures in the presence of normal radiographs or uncertain diagnosis Chapter 82 Ankle Sprain/Fracture Rishin J. Kadakia and Jason T. Bariteau

What defines a high ankle Syndesmotic injury sprain? What ligament is most Anterior talofibular ligament commonly damaged in ankle (ATFL) sprains What are the three lateral Anterior talofibular ligament ligaments of the ankle joint? (ATFL), calcaneofibular ligament (CFL), posterior talofibular ligament (PFL) What are common associated Osteochondral fractures/defects, injuries seen in patients with peroneal tendon pathology ankle sprains (continued)

R. J. Kadakia, MD (*) · J. T. Bariteau, MD Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA e-mail: [email protected]

© Springer International Publishing AG, part of Springer Nature 2018 183 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_82 184 R. J. Kadakia and J. T. Bariteau

(continued) What radiograph view can be External rotation stress view used to identify a syndesmotic injury? What is the normal Less than or equal to 4 mm measurement for the medial clear space? What is the normal Less than or equal to 6 mm measurement for the tibiofibular clear space? What imaging modality MRI when evaluated for tendon pathology or osteochondral defects What are the indications for Persistent pain and/or surgery for ankle sprains instability after a long period of nonoperative treatment What is the name of the Brostrom procedure/modified procedure involving anatomic Brostrom procedure reconstruction of the lateral ankle ligaments? What is name of one Lauge-Hansen classification system for ankle fractures? What is the most common Supination external rotation type of ankle fracture based on the Lauge-Hansen system? Chapter 83 Talar Fracture Gregory R. Waryasz

What is the mechanism Forced dorsiflexion with axial load of a talar neck fracture? What does the lateral Posterior facet of calcaneus and lateral process of the talus malleolus of fibula articulate with? What Hawkins Hawkins IV classification has the highest risk of AVN? What is a Canale view? Optimal view of talar neck. Maximum equinus, 15° pronation, and X-ray 75° cephalad from horizontal What should be done Clean, reduce, and ORIF with an extruded talus? (continued)

G. R. Waryasz, MD, CSCS Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA

(continued) What is a Hawkins Subchondral lucency seen on mortise sign? X-ray at 6–8 weeks representing intact vascularity and resorption of subchondral bone What does a varus talar Decreased subtalar eversion and malunion lead to? weightbearing on the lateral border of foot Chapter 84 Calcaneus Fracture Rishin J. Kadakia and Jason T. Bariteau

What is the most commonly fractured The calcaneus bone in the foot? What is the most common mechanism Axial loading of the of injury that causes calcaneus foot fractures? The calcaneus articulates with which Talus and cuboid other bones? How many facets are located on Three the superior articular surface of the calcaneus? The middle facet is located on the Flexor hallucis longus sustentaculum tali of the calcaneus, which tendon passes below this structure? (continued)

R. J. Kadakia, MD (*) · J. T. Bariteau, MD Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA e-mail: [email protected]

© Springer International Publishing AG, part of Springer Nature 2018 187 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_84 188 R. J. Kadakia and J. T. Bariteau

(continued) What angles obtained on a lateral Angle of Gissane and radiograph of the calcaneus are used to Bohler’s angle evaluate calcaneus fractures? What other part of the body must Lumbar spine (high be imaged in patients with calcaneus incidence of vertebral fractures? injuries) Which classification system for Sanders classification calcaneus fractures requires CT scans and examines the articular fragments on coronal cuts? What radiographic view is typically Harris view obtained for calcaneus fractures that allows for visualization of the tuberosity and fracture alignment (varus/valgus)? What is the most common deformity Lateral wall blow out seen with calcaneus fractures? with varus deformity and shortening of the calcaneus Which facet of the subtalar joint is The posterior facet most commonly fractured with intraarticular calcaneus fractures? Chapter 85 Lisfranc Fracture Gregory R. Waryasz

What is the mechanism of Hyperflexion/compression/abduction a Lisfranc fracture? moment on forefoot and transmitted to the TMT articulation What are the articulations Tarsometatarsal, intermetatarsal, of the Lisfrac joint intertarsal complex? What the Lisfranc Medial cuneiform to base of second ligament connect? metatarsal on plantar surface Where is the bruising Plantar ecchymosis sign usually present with a Lisfranc? What is the indication Greater than 2 mm displacement at for ORIF with Lisfranc the Lisfranc articulation injury? (continued)

G. R. Waryasz, MD, CSCS Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA

(continued) What position do you Passive abduction and pronation of place the foot in to stress the forefoot with a fixed hindfoot the Lisfranc Ligament? Chapter 86 Metatarsal Fracture Seth W. O’Donnell and Brad D. Blankenhorn

Where is the most common Second MT location of metatarsal (MT) stress fractures? What injury must be Lisfranc/Lisfranc equivalent injuries looked for with multiple proximal MT fractures? Do MT fractures need Most heal with conservative surgery? treatment What medical workup Metabolic bone disease/amenorrhea should occur in females with MT stress fractures? What is the primary Stiff soled shoe or CAM walker nonoperative treatment? boot (continued)

S. W. O’Donnell, MD (*) · B. D. Blankenhorn, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 191 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_86 192 S. W. O’Donnell and B. D. Blankenhorn

(continued) What is a Jones fracture? Fracture of the fifth MT base in the “watershed” region of poor bone healing/often involving the MT— cuboid articulation What is a dancer’s fracture? Fracture of the fifth MT shaft How long should patients Most MT fractures can bear remain non-weightbearing? immediate weight as tolerated Chapter 87 Pilon Fracture Seth W. O’Donnell and Brad D. Blankenhorn

Define a pilon fracture Fracture of tibial plafond, involves articular surface of distal tibia, often from a high energy axial load What is the chaput fragment? Fragment attached to anterior inferior tibiofibular ligament, anterolateral aspect of distal tibia What initial treatment is External fixation often used? What advanced imaging CT scan (obtain after reduction can be used to gather more and external fixation) information about the fracture? (continued)

S. W. O’Donnell (*) · B. D. Blankenhorn, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 193 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_87 194 S. W. O’Donnell and B. D. Blankenhorn

(continued) What is a common risk factor Smoking for wound or bone healing issues? What structure is the Volkmann fragment of the distal posterior inferior tibiofibular tibia ligament attached to? What is the fibular Wagstaff fragment attachment of the anterior inferior tibiofibular ligament called? Chapter 88 Achilles Tendon Pathology Gregory R. Waryasz

Where does an Achilles rupture 4–6 cm above calaneal insertion usually occur? in the hypovascular area What antibiotic class is Fluoroquinolones associated with Achilles ruptures? What is a Thompson test? Lack of plantarflexion when the calf is squeezed What is the tendon can be Flexor hallucis longus transferred in chronic Achilles rupture cases? What nerve is directly lateral to Sural the Achilles tendon? What are some risk factors to Smoking, females, steroid use, wound healing complications open technique following Achilles repair? (continued)

G. R. Waryasz, MD, CSCS Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA

(continued) What is the first line of Activity modification, shoe treatment for insertional wear modification, physical Achilles tendinopathy? therapy What is the histology Disorganized collagen with of insertional Achilles mucoid degeneration. Few tendinopathy? inflammatory cells. Sometimes calcium deposits Chapter 89 Diabetic Foot Seth W. O’Donnell and Brad D. Blankenhorn

What is the most etiology of Peripheral neuropathy diabetic foot ulcers? What test is more sensitive Semmes-Weinstein 5.07 than light touch or two- monofilament point discrimination for determining loss of protective sensation? What are some radiographic Osteopenia, sclerosis, findings of Charcot foot? fragmentation, joint collapse, and destruction What ABI is needed to 30–40 mmHg in toes and ensure adequate vascular >70 mmHg at the ankle health for healing? (continued)

S. W. O’Donnell, MD (*) · B. D. Blankenhorn, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 197 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_89 198 S. W. O’Donnell and B. D. Blankenhorn

(continued) What classification system is Wagner: 0—At risk, skin intact; used to grade ulcers? 1—Superficial; 2—Deep without infection; 3—Deep infection; 4— Gangrene distal to midfoot; 5— Proximal gangrene What are the most common Staph and strep species infectious organisms? Why should anaerobic 1/3 of infected diabetic feet have antibiotic coverage be positive anaerobic cultures considered? What is the primary Total contact casting, frequent treatment when no infection re-evaluation and skin checks is present? Chapter 90 Charcot Arthropathy Rishin J. Kadakia and Jason T. Bariteau

Define charcot arthropathy? Progressive disorder involving destruction of bones and joints due to loss of protective sensation What is the most common Diabetes cause of charcot arthropathy in the foot and ankle? What other joints are Knee, shoulder, elbow commonly affected by charcot arthropathy? What are the symptoms of Swelling, warmth, erythema, not charcot arthropathy in the always painful foot and ankle? (continued)

R. J. Kadakia, MD (*) · J. T. Bariteau, MD Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA e-mail: [email protected]

© Springer International Publishing AG, part of Springer Nature 2018 199 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_90 200 R. J. Kadakia and J. T. Bariteau

(continued) How can you differentiate Erythema will decrease when the infection from charcot extremity is elevated in charcot arthropathy in the foot and arthropathy ankle? What test is used commonly Semmes-Weinstein monofilament used to diagnose diabetic testing neuropathy in charcot? What is the first line Total contact casting following by treatment for charcot a CROW boot arthropathy in the foot and ankle? What inflammatory markers ESR and WBC are elevated in charcot arthropathy? Why is deformity correction High complication rates with or arthrodesis not the best operative intervention treatment strategy? What are the temporal stages Fragmentation, coalescence, for progression of charcot reconstruction arthropathy? What is the name of the Brodsky classification anatomic classification system for charcot arthropathy? Chapter 91 Tarsal Tunnel Syndrome Brian H. Cohen

What is the tarsal A fibroosseous tunnel located at the tunnel? What are posteromedial ankle and hindfoot, the flexor the borders of the retinaculum is roof and extends from the tarsal tunnel? medial malleolus to the medial side of the calcaneal tuberosity. The medial distal tibia, talus, and calcaneus make up the floor What is the Posterior tibial tendon, flexor digitorum content of the longus tendon, posterior tibial artery and tarsal tunnel in veins, tibial nerve and flexor hallucis longus order from medial tendon, (mnemonic to help remember order: to posterior? What Tom Dick and a Very Nervous Harry) is a mnemonic to remember? (continued)

B. H. Cohen MD Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) When dissecting Flexor hallucis longus on the medial side of ankle which muscle has the most distal muscle belly? What are the three Medial calcaneal nerve, lateral plantar terminal branches nerve, and medial plantar nerve, within of the tibial nerve? the tarsal tunnel just proximal and deep to Where do they the superior edge of the abductor hallucis branch? Which muscle, the medial calcaneal nerve branches branches first? first What is tarsal Tibial nerve entrapment beneath the flexor tunnel syndrome? retinaculum or tarsal canal What are some Bone from prior distal tibial, talar, or causes of tarsal calcaneal fractures, tenosynovitis, ganglia/ tunnel syndrome? cysts from a tendon sheath or subtalar/ tibiotalar joints, bone and soft tissue from rheumatoid arthritis or ankylosing spondylitis, varicosities, neural tumor, tarsal coalition, and fixed valgus hindfoot which can cause a chronic traction neuropathy What are some Dysthesias in the plantar aspect of the foot, clinical findings toes, or medial distal calf of tarsal tunnel syndrome? What are the (1) Triple compression test—ankle is plantar two types of flexed and the foot is inverted, then digital provocative test? compression is applied over the tibial nerve (2) Dorsiflexion-eversion test— maximally evert the foot and dorsiflex the ankle passively, with all the metatarsophalangeal joints maximally dorsiflexed, hold position is held for 5–10 s 91 Tarsal Tunnel Syndrome 203

(continued) What test should MRI, as most cases are caused by a space- you order? occupying lesions Electrodiagnostic testing can be normal in patients with tarsal tunnel syndrome, helps rule out systemic neuropathies, a negative electrodiagnostic testing is not a contraindication for surgery What are some 6–12 weeks of ankle immobilization in a conservative night splint, anti-inflammatory agents, and treatment options? shoe modification or orthosis, be careful with corticosteroid injections in this area as concern for tendon attenuation or rupture What are the Surgical decompression of tibial nerve. surgical options? Patients with space-occupying lesions Which patients do respond better to surgical decompression better? than those with idiopathic or traumatic causes, if no identifiable cause relief of symptoms is not predictable Chapter 92 Peroneal Tendon Pathology Seth W. O’Donnell and Brad D. Blankenhorn

Where do peroneal tendons Posterior lateral ankle cause pain? What structure is often damaged Superior peroneal when peroneal tendons dislocate? retinaculum (SPR) What provocative test can Pain and tenderness in identify peroneal pathology? the posterior-lateral ankle which increases with resisted eversion If symmetric weakness to Charcot-Marie-Tooth eversion testing is present, what additional pathology should be considered? What X-ray finding can suggest “Fleck sign”—an avulsion of instability of the peroneal the distal fibular insertion of tendons? the SPR (continued)

S. W. O’Donnell, MD (*) · B. D. Blankenhorn, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 205 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_92 206 S. W. O’Donnell and B. D. Blankenhorn

(continued) What is the orientation of the Peroneus brevis is anterior to tendons behind the fibula? peroneus longus What is the common mechanism Forced inversion of a plantar of peroneal injury? flexed foot What imaging study can be Ultrasound helpful for dynamic information about the tendons? What imaging study is the gold MRI standard for tendon/soft tissue pathology? Chapter 93 Flatfoot Seth W. O’Donnell and Brad D. Blankenhorn

What musculo-tendinous structure is Posterior tibial often found to be insufficient? What is another term for the Spring ligament superiomedial calcaneonavicular ligament? In children with recurrent ankle Tarsal coalition sprains or rigid flatfoot, what pathology should be evaluated? What muscle antagonizes the Peroneus brevis posterior tibialis? What is the major difference between Flexible deformity (Stage Stage II and Stage III flatfoot II) vs. Rigid deformity deformity? (Stage III) (continued)

S. W. O’Donnell, MD (*) · B. D. Blankenhorn, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 207 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_93 208 S. W. O’Donnell and B. D. Blankenhorn

(continued) Why can patients hurt on the outside Subfibular impingment of their ankle in severe disease? What is the too many toes sign? An indicator of forefoot abduction, usually seen in Stage IIb disease Chapter 94 Plantar Fasciitis Gregory R. Waryasz

What are risk factors for Obesity, decreased ankle dorsiflexion, plantar fasciitis? weight bearing endurance activities (dancing and running) What are the symptoms Insidious onset of heel pain, often of plantar fasciitis? first steps of day Where is the patient Medial tuberosity of calcaneus/origin usually most tender with of the plantar fascia medially plantar fasciitis? What is Baxter’s nerve? First branch of lateral plantar nerve that can lead to heel pain around the origin of the abductor hallucis What is the first line of Pain control, splinting, stretching treatment for plantar programs fasciitis? (continued)

G. R. Waryasz, MD, CSCS Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA

(continued) How much of the plantar Medial 1/3–2/3. Do not perform a fascia is released for complete release chronic plantar fasciitis? How is a plantar fascia Cast or boot immobilization rupture treated? Chapter 95 Morton Neuroma Seth W. O’Donnell and Brad D. Blankenhorn

Which is the most common Between the third and fourth toes location for a Morton’s (third web space) of the foot Neuroma? What structure frequently Intermetatarsal ligament causes the compression? What structures are Interdigital branches from both frequently compressed? medial and lateral plantar nerves What are the disadvantages Increased wound problems, painful to a plantar surgical scar on the weight bearing surface approach? of the foot What are some common Wide toe-box shoes, steroid nonoperative therapies? injection, metatarsal pad

S. W. O’Donnell, MD (*) · B. D. Blankenhorn, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 211 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_95 Chapter 96 Arthritic Foot Seth W. O’Donnell and Brad D. Blankenhorn

What joints are fused in Subtalar, talo-navicular, calcaneo- a triple fusion? cuboid What is another term for Talo-calcaneal joint the subtalar joint? What is the difference Ankle arthrodesis involves a fusion of between ankle the tibio-talar joint; ankle arthroplasty arthrodesis and ankle involves replacing the tibio-talar joint arthroplasty? with prosthetic implants Which fractures can Calcaneal fractures lead to increased risk of subtalar arthritis? What is the major risk of Abnormal loading of adjacent joints joint fusion? with degeneration

S. W. O’Donnell, MD (*) · B. D. Blankenhorn, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 213 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_96 Chapter 97 Pelvic Ring Fractures Daniel Brian Carlin Reid

What X-ray view is best for evaluating Inlet view anterior/posterior translation of the hemipelvis, internal/external rotation of the hemipelvis, and SI joint widening? What X-ray view is best for evaluating Outlet view vertical translation of the hemipelvis and flexion-extension of the hemipelvis? What is the most important Posterior sacroiliac ligamentous structure for pelvic ligamentous complex stability? What are the three main injury Anterior posterior mechanism patterns described in the compression (APC), Young-Burgess classification? lateral compression (LC), vertical shear (VS) (continued)

D. B. C. Reid, MD, MPH Department of Orthopaedics, Rhode Island Hospital, Brown University, Providence, RI, USA

(continued) Injury to which structure differentiates Posterior sacroiliac between and APC-II and APC-III ligamentous complex injury What is the colloquial name for and Windswept pelvis LC-III injury? (Ipsilateral LC injury with contralateral APC- type injury) In general, which pelvic injury pattern Vertical shear (VS) is associated with the highest risk of bleeding and hypovolemic shock? What device can easily be applied in Pelvic binder the emergency room to control pelvic hemorrhage in unstable pelvic ring injuries? What anatomic landmark should a Greater trochanters pelvic binder be centered over during application? What fluoroscopic views best define Inlet view (anterior- the anterior-posterior and superior- posterior), outlet view, inferior trajectories, respectively, for (superior-inferior) iliosacral screw placement? What nerve root is at greatest risk L5 when placing S1 iliosacral screws? Chapter 98 Acetabular Fractures Daniel Brian Carlin Reid

What are the two oblique Obturator oblique: Anterior column, pelvis (“Judet”) X-ray posterior wall. Iliac oblique: Posterior views and what do each column, anterior wall view best? What are the five Posterior wall, posterior column, “simple” types of anterior wall, anterior column, acetabular fractures? transverse (Letournal classification) What are the five Posterior column/posterior “associated” types of wall, transverse/posterior wall, acetabular fractures? T-type, anterior column/posterior (Letournal classification) hemitransverse, associated both column What feature defines an Complete dissociation between associated both column acetabular articular surface and intact acetabular fracture? ilium (continued)

D. B. C. Reid, MD, MPH Department of Orthopaedics, Rhode Island Hospital, Brown University, Providence, RI, USA

(continued) Name a common Heterotopic ossification (HO). complication after Prophylaxis can include radiation operative fixation of therapy or indomethacin acetabulum fractures and how it can be prevented. How can the lower Hip extension and knee flexion extremity be positioned during surgery to minimize tension on the sciatic nerve? What type of injury Indicates associated both column does the “spur sign” on acetabular fracture. Represents intact the obturator oblique portion of iliac wing remaining in indicate and what does anatomic position as the acetabular this sign represent? dome and femoral head are translated medially Part IV Spine

219 Chapter 99 Vertebral Disc Disease Dominic Kleinhenz

What is the function of the Shock absorption and intervertebral disc? mobility What are the components of the Nucleus pulposus, anulus intervertebral disc? fibrosus What types of collagen make up Type II (nucleus pulposus), those components? Type I (anulus fibrosus) How does water content in the It decreases disc change with aging? How does less water affect the It becomes weaker and more disc? stiff (continued)

D. Kleinhenz, MD Rhode Island Hospital Orthopaedic Surgery Residency Program, Warren Alpert School of Medicine of Brown University, Providence, RI, USA

(continued) What is a disc protrusion? Displaced nucleus that has not extended beyond the anulus What is a disc extrusion? Displaced nucleus through the anulus What is a disc sequestration? “Free fragment,” displaced nucleus no longer in contact with disc What nerve root(s) do central Traversing (L4/5 disc and paracentral disc herniations herniation leads to L5 effect? radiculopathy) What nerve root (s) do foraminal Exiting (L4/5 disc herniation and extra-foraminal disc leads to L4 radiculopathy) herniations effect? Chapter 100 Spondylolysis and Spondylolisthesis Dominic Kleinhenz

What is the pars Area between the superior and interarticularis? inferior intraarticular processes What is spondylolysis? A defect in the pars interarticularis What X-ray views look for Right and left oblique spondylolysis? What are X-ray findings of “Scottie dog with a collar,” spondylolysis? lucency of the pars interarticularis seen on oblique views of the spine What is the common clinical A child or adolescent with back presentation for spondylosis? pain (continued)

D. Kleinhenz, MD Rhode Island Hospital Orthopaedic Surgery Residency Program, Warren Alpert School of Medicine of Brown University, Providence, RI, USA

(continued) What sport(s) have higher Gymnastics and football. incidence of spondylosis? Sports with repetitive lumbar hyperextension Most common exam Hamstring tightness finding in spondylolysis/ spondylolisthesis? What is spondylolisthesis? Slippage of one vertebral body on another What are the types of Isthmic, degenerative, traumatic spondylolisthesis? What type of Isthmic spondylolisthesis is caused by the defect in the pars? Chapter 101 Spinal Stenosis Dominic Kleinhenz

What is spinal Narrowing of the spinal canal leading to stenosis? pressure on the neural elements What defines cervical Absolute cervical stenosis is defined by stenosis? canal diameter <10 mm. Relative cervical stenosis is defined by canal diameter between 10 and 13 mm What structures are Intervertebral disc, ligamentum flavum, pathologic in lumbar facet joints spinal stenosis? What is neurogenic A common symptom of spinal stenosis. claudication? Onset of bilateral buttock or leg pain after walking a certain distance (continued)

D. Kleinhenz, MD Rhode Island Hospital Orthopaedic Surgery Residency Program, Warren Alpert School of Medicine of Brown University, Providence, RI, USA

(continued) How do you Examining peripheral pulses differentiate neurogenic and vascular claudication? What is the “shopping Patients with spinal stenosis typically cart” sign? feel better in a flexed position. Thus, they feel better when leaning forward on the shopping cart Why do patients with Flexion tightens the hypertrophied spinal stenosis feel ligamentum flavum taking some pressure better in flexion? off the thecal sac Which nerve root L5 is most commonly affected in spinal stenosis? Where can the Centrally or in the lateral recess at L5 nerve root be L4/5, or in the L5/S1 foramen or extra- compressed? foraminal zone Chapter 102 Spinal Cord Injury Jacob Babu

What should be done Spinal precautions/stabilization, leave on the field for a helmet in place, remove facemask football player with concern of cervical spine injury? What tract is Spinothalamic tract responsible for relaying pain and temperature sensation from the body to the brain? (continued)

J. Babu, MD, MHA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA e-mail: [email protected]

(continued) What American Spinal A: Complete injury: No preserved Injury Association sensory or motor function, including in (ASIA) grade is sacral segments a SCI injury that B: Sensory incomplete: Complete leaves a patient with motor deficits distal to the no motor function, neurological level, but some sensory but preserved anal is preserved. Sensation is preserved sensation? in the anal region and patient may recognize light touch or pin prick in this area C: Motor incomplete: Motor preservation with less than half of the key muscles below the level of injury having a muscle grade of 3 or above. Voluntary anal contraction is found on physical exam D: Motor incomplete: Motor preservation with half or more of the key muscles below the level of injury having a muscle grade of 3 or above E: Normal sensation and motor throughout What level of spinal Injury to C3 or above cord injury results in need for mechanical ventilation? What physical exam Loss of the bulbocavernosus reflex maneuver can help identify if a patient is in spinal shock? Decreased blood Neurogenic shock pressure and decreased heart rate is consistent with what type of shock? 102 Spinal Cord Injury 229

What should the MAPs >85 mmHg mean arterial pressure (MAP) be maintained at or above to prevent further ischemic damage to the spinal cord? What preexisting Cervical central stenosis/spondylosis condition predisposes a patient to central cord syndrome? Which spinal cord Anterior cord injury injury pattern results in preservation of the dorsal columns, with loss of motor and sensory function below the level of injury? Which incomplete Brown-Sequard syndrome spinal cord injury pattern is associated with the greatest prognosis for functional recovery? Chapter 103 Cervical Fracture/Dislocation Jacob Babu

Why is spinal cord injury more The spinal canal is much common in fracture/dislocations of larger proximally the subaxial (C3-C7) cervical spine than at C1/C2? What are some radiographic The power ratio, basion-dens parameters that help identify interval, basion-axial interval occipitocervical dissociation? What ligament is the key The transverse atlantal component to maintaining stability ligament (TAL) in C1 atlas fractures? What type of odontoid fracture Type 2 fracture is most likely to go on to a nonunion? (continued)

J. Babu, MD, MHA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA e-mail: [email protected]

(continued) What conditions should increase Ankylosing spondylitis, the practitioners level of concern diffuse idiopathic skeletal for radiographically occult or hyperostosis (DISH), minimally displaced cervical spine ossification of the posterior fractures? longitudinal ligament What axial CT scan finding is Reverse hamburger sign— suggestive of jumped cervical articular surface of facets facets? are no longer in contact What should be done for an Emergent closed reduction identified cervical facet dislocation with sequential traction and progressive neurological worsening in the alert and cooperative patient? Chapter 104 Thoracolumbar Fracture Jacob Babu

What is the normal range of thoracic 20–50° kyphosis? At what level does the spinal cord L1-L2 terminate and continue as the cauda equina? The integrity of what structure The posterior suggests possibly maintained stability ligamentous complex in the thoracolumbar spine despite sustaining a burst fracture? What other injury occurs with high Abdominal viscera frequency concomitantly with flexion- injuries distraction injuries or “seat belt injuries”? (continued)

J. Babu, MD, MHA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA e-mail: [email protected]

(continued) What scoring system helps guide The Thoracolumbar practitioners on whether to manage Injury Classification and thoracolumbar fractures operatively Severity Score (TLICS) vs. nonoperatively? What deformity does a practitioner Progressive kyphosis monitor for with radiographs at follow up when managing a patient with a 2–3 column fracture nonoperatively? What is the potential etiology of Epidural hematoma— progressive neurologic deficits in a especially when spine fracture suffered by a patient anticoagulated with ankylosis spondylitis or DISH? What is the greatest predictor Prior vertebral of a patient suffering a vertebral compression fractures compression fracture in the future? What medical management can help Bisphosphonates prevent future vertebral compression, fragility fractures? Chapter 105 Lumbar Spine Conditions Eren O. Kuris

What percentage of the 54–80% general population will experience low back pain at some point in their lifetime? What is the most Muscle strain common cause of low back pain? What percentage of low 90% back pain resolves within 1 year? What are risk factors for Obesity low back pain? (continued)

E. O. Kuris, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What is the differential Muscle strain diagnosis for low back Disk herniation pain? Spinal stenosis Lumbar radiculopathy Abdominal aortic aneurysm Degenerative spinal conditions (such as spondylolisthesis) When should you order If pain persists and does not respond imaging for low back to conservative treatment options pain? (such as activity modification, NSAIDs, physical therapy) What are some red Signs or symptoms of infection (fever, flags that indicate that chills, etc) imaging should be History of cancer obtained sooner? Trauma Neurologic symptoms Symptoms concerning for cauda equina syndrome (bowel or bladder changes) What are Waddell signs? A system used to evaluate a patient for non-organic causes of back pain – superficial and non-anatomic tenderness – excessive verbalization or gesturing of pain – nonanatomic motor or sensory impairment – pain with axial compression or simulated rotation of spine – negative straight leg raise when patient is distracted The presence of three or more of these findings suggests a non-organic cause of the patient’s low back pain 105 Lumbar Spine Conditions 237

Suggested Reading

1. Biyani A, Andersson GB. Low back pain: pathophysiology and management. J Am Acad Orthop Surg. 2004;12(2):106–15. Review. PubMed PMID: 15089084. 2. Herkowitz HN, Garfin SR, Eismont FJ, Bel GR, Balderston RA. Rothman-Simeone The spine. 6th ed. Philadelphia, PA: Saunders; 2011. 3. Shen FH, Samartzis D, Andersson GB. Nonsurgical management of acute and chronic low back pain. J Am Acad Orthop Surg. 2006;14(8):477–87. Review. PubMed PMID: 16885479. 4. Waddell G, McCulloch JA, Kummel E, Venner RM. Nonorganic physical signs in low-back pain. Spine (Phila Pa 1976). 1980;5(2):117–25. PubMed PMID:6446157. Chapter 106 Adult Spinal Deformity Dominic Kleinhenz

What are the normal Lumbar lordosis, thoracic kyphosis, sagittal curves of the cervical lordosis spine? What is sagittal vertical Measurement of sagittal balance; plumb axis? line from center of C7 to vertical line from posterosuperior corner of S1 What measurement Greater than 5 cm sagittal vertical axis, defines abnormal PT > 20°, PI-LL > 10° positive sagittal balance? What is pelvic Angle formed between a line drawn incidence? from the center of the femoral heads and a line perpendicular to the sacral endplate drawn from its midpoint (continued)

D. Kleinhenz, MD Rhode Island Hospital Orthopaedic Surgery Residency Program, Warren Alpert School of Medicine of Brown University, Providence, RI, USA

(continued) Why is pelvic incidence It is a fixed pelvic parameter; it varies important? from person to person, but does not change with positioning of spine or pelvis How is lumbar lordosis A cobb angle is drawn from superior measured? endplate of L1 and caudal endplate of L5 What is the relationship Pelvic incidence should match lumbar between pelvic lordosis within 10° incidence and lumbar lordosis? How do patients Through retroversion of their pelvis compensate for and hip and knee flexion abnormal sagittal balance? Why are patients with Patients lose their ability to compensate adult spinal deformity throughout the day worse at end of day? Chapter 107 Spine Tumors Eren O. Kuris

What is the most common tumor Metastatic disease of the spine? What primary tumors most Breast, prostate, lung, kidney, frequently metastasize to bone? and thyroid What percentage of spinal column 97% tumors are from metastatic disease? Where is the most common Spine, specifically, the site of bony metastasis from a thoracic spine (second most malignancy? common is proximal femur) What other conditions are Multiple myeloma associated with spine tumors? Lymphoma (continued)

E. O. Kuris, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What scoring system can Takuhashi scoring system determine life expectancy in a patient with spine metastasis? When is palliative treatment recommended? When the life expectancy is less than 6 months What are the goals of treatment Neurological decompression for metastatic spine lesions? Surgical stabilization What adjuvant treatment can Radiation be used either before or after surgery? If a patient has metastatic renal Preoperative embolization cell carcinoma, what procedure to minimize bleeding should the patient undergo before surgical resection and stabilization of the lesion? Where do most malignant tumors Anteriorly (vertebral body) occur in the spine vertebrae Where do most benign spine Posterior elements tumors occur? What are some primary benign Osteoblastoma/Osteoid spine tumors? Osteoma Giant cell tumor Aneurysmal bone cyst Osteochondroma Hemangioma What are some primary malignant Chordoma spine tumors? Osteosarcoma Ewing’s sarcoma Chondrosarcoma 107 Spine Tumors 243

How do you distinguish Size (<2 cm in diameter is between osteoid osteoma and osteoid osteoma; >2 cm is osteoblastoma? osteoblastoma) How is an osteoid osteoma/ Painful scoliosis osteoblastoma commonly found in (nonrotational) children? Where do osteoid osteoma and Posterior vertebral elements osteoblastoma usually occur in the spine? What is the most common primary Chordoma malignant spine tumor in adults? What is the most common site for Sacrum and coccyx (50% of a chordoma? chordomas) What are the histological features? Vacuolated physaliferous cells with a foamy appearance What is the 5-year survival rate in 60% patients with chordoma?

Suggested Reading

1. Herkowitz HN, Garfin SR, Eismont FJ, Bel GR, Balderston RA. Rothman-Simeone The spine. 6th ed. Philadelphia, PA: Saunders; 2011. 2. Schwab JH, Healey JH, Rose P, et al. The surgical management of sacral chordomas. Spine. 2009;34:2700–4. 3. Tokuhashi Y, Ajiro Y, Umezawa N. Outcome of treatment for spinal metastases using scoring system for preoperative evaluation of prognosis. Spine (Phila Pa 1976). 2009;34(1):69–73. https://doi. org/10.1097/BRS.0b013e3181913f19. PubMed PMID: 19127163. Chapter 108 Spine Infections Eren O. Kuris

What are the various Spinal epidural abscess types of spine Vertebral osteomyelitis infections? Discitis Granulomatous infections (such as spinal tuberculosis) Postoperative wound infections Spinal Intradural infections (continued)

E. O. Kuris, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What are risk factors History of IV drug use for spine infections? Immunocompromised state Malignancy Diabetes Malnutrition Recent systemic infection History of spinal procedure History of travel to an endemic region Immunosuppressive medications What is the most Staphylococcus aureus common pathogen? What pathogen may be Pseudomonas aeruginosa present in patients with a history of IV drug use? What is a spinal A bacterial infection of the spine that epidural abscess? leads to a collection of pus between the dura and the tissue around it How can spine Systemic symptoms (such as fevers, infections present? chills, malaise) Pain (can be acute or insidious onset) Physical examination may reveal neurological deficits in severe cases (such as radiculopathy, myelopathy, or cauda equina syndrome) 108 Spine Infections 247

What labs should be – WBC count ordered in the work-up – ESR of spine infections? – CRP – If there is concern for a systemic infection, consider chest X-ray, blood cultures, and a urinalysis What imaging study MRI with gadolinium contrast is generally the gold standard for the evaluation of spine infections? When should you begin After cultures have been obtained, antibiotics? unless the patient is systemically ill or has risk of neurological deterioration What is the treatment Surgical decompression with or without for spinal epidural stabilization abscess? What is the first line of Bracing with an extended course of IV treatment for vertebral antibiotics (after a pathogen has been osteomyelitis? identified through blood cultures or biopsy) How can you monitor Serial inflammatory markers, such as the activity of spine ESR and CRP infections?

Suggested Reading

1. Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006;355(19):2012–20. Review. PubMed PMID: 17093252. 2. Herkowitz HN, Garfin SR, Eismont FJ, Bel GR, Balderston RA. Rothman-Simeone The spine. 6th ed. Philadelphia, PA: Saunders; 2011. 3. Tay BK, Deckey J, Hu SS. Spinal infections. J Am Acad Orthop Surg. 2002;10(3):188–97. Review. PubMed PMID: 12041940. Part V Pediatric Orthopedics Chapter 109 Angular Variations Heather Hansen

What exam components Foot-progression angle, internal and are including in the external rotation of the hips, thigh-foot rotational profile? angle, and any foot deformities What is the foot- A measurement of the degree of progression angle? intoeing or outtoeing compared to an imaginary straight line on the floor What does the internal The femoral rotational variation/ and external rotation of torsion the hip measure? What is the thigh-foot With the child prone, the angle angle and what does it between the axis of the thigh and the measure? axis of the foot with the foot held in a neutral position. It measures tibial torsion (continued)

H. Hansen, MD Division of Pediatric Orthopaedic Surgery, Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the typical Genu varum (bowlegged) as infant, progression of the genu valgum (knock-kneed) from age tibiofemoral angle in a 2 to 4 young child? What is the average 7° of valgus adult tibiofemoral angle? What are some benign Metatarsus adductus, increased or causes of intoeing? persistent internal tibial torsion, or increased or persistent femoral anteversion What are some Cerebral palsy, infantile Blount’s, pathologic causes of metabolic bone disease, skeletal intoeing? dysplasias What are the main Guided growth or osteotomies surgical strategies for symptomatic angular variations?

Bibliography

1. Aronsson DD, Lisle JW. The pediatric orthopaedic examination. In: Weinstein SL, editor. Lovell and Winter’s pediatric orthopaedics, vol. 1. 7th ed. Philadelphia: Wolters Kluwer; 2014. p. 91–5. Print. 2. Birch JG. The orthopaedic examination: a comprehensive over- view. In: Herring JA, editor. Tachjian’s pediatric orthopaedics: from the Texas Scottish Rite Hospital, vol. 1. 5th ed. Philadelphia: Elsevier Saunders; 2014a. p. 25–6. Print. 3. Birch JG. The orthopaedic examination: clinical application. In: Herring JA, editor. Tachjian’s pediatric orthopaedics: from the Texas Scottish Rite Hospital, vol. 1. 5th ed. Philadelphia: Elsevier Saunders; 2014b. p. 63–4. Print. 4. Lincoln TL, Suen PW. Common rotational variations in children. J Am Acad Orthop Surg. 2003;11:312–20. Chapter 110 Pediatric Fractures: Management Principles Aristides I. Cruz Jr

What are the minimum Two (typically AP and lateral) number of views one should order when evaluating a fractured extremity? What is the most Distal radius common fracture reported in children? Which specific types of Metaphyseal corner fractures, long fractures are associated bone fractures in child of non-walking with abuse/non- age, posterior rib fractures, distal accidental trauma? humerus transphyseal fracture, multiple fractures in various stages of healing (continued)

A. I. Cruz Jr., MD, MBA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) Through which physeal Zone of hypertrophy zone do Salter-Harris I fractures typically occur? Which clinical finding Increasing pain medicine requirement is most indicative of impending compartment syndrome in a child? What are Harris growth These lines result from a temporary arrest lines? slowdown of normal longitudinal growth after injury or illness and appear as transversely oriented, sclerotic lines on plain X-ray and usually duplicate the contiguous physeal contour Chapter 111 Radial Head Dislocation Aristides I. Cruz Jr.

What is a Monteggia fracture? Ulnar shaft fracture associated with radial head dislocation What is the Bado classification Describes Monteggia fractures scheme? relative to direction of radial head dislocation. Type I: Anterior dislocation Type II: Posterior dislocation Type III: Lateral dislocation Type IV: Dislocation + radius fracture What is the treatment for Observation asymptomatic congenital radial head dislocation? (continued)

A. I. Cruz Jr., MD, MBA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) Which direction is the Posterior radial head most commonly dislocated in congenital radial head dislocation? Which motion(s) is/are most Elbow extension/forearm commonly lost in congenital supination radial head dislocation? Which radiographic line should Radiocapitellar line be measured when evaluating for radial head dislocation? Chapter 112 Slipped Capital Femoral Epiphysis Heather Hansen

What are risk factors for Obesity, polynesian ancestry, SCFE? endocrinopathies, radiation therapy, renal osteodystrophy, Down syndrome What is the more useful Stable vs. unstable, acute vs. chronic classification of SCFE? What defines an Inability to weight bear, even with unstable SCFE? crutches What is a major concern Osteonecrosis of the femoral head with unstable SCFEs? What are the common Hip/groin pain, limp, decreased range findings of SCFE? of motion of the hip, and KNEE or THIGH pain (continued)

H. Hansen, MD Division of Pediatric Orthopaedic Surgery, Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA

(continued) What is the obligate The hip automatically falls into external rotation sign? external rotation with hip flexion What radiographic view Lateral view is most sensitive for detecting SCFEs? What is Klein’s line? A line drawn tangential to the superior femoral neck on the lateral hip radiograph What is the presumed Development of osteoarthritis natural history of a severe slip? What is the current Operative fixation accepted treatment of SCFEs?

Bibliography

1. Kay RM, Kim Y-J. Slipped capital femoral epiphysis. In: Weinstein SL, editor. Lovell and Winter’s pediatric orthopaedics, vol. 2. 7th ed. Philadelphia: Wolters Kluwer; 2014. p. 1165–221. Print. 2. Herring JA. Slipped capital femoral epiphysis. In: Herring JA, editor. Tachjian’s pediatric orthopaedics: from the Texas Scottish Rite Hospital, vol. 2. 5th ed. Philadelphia: Elsevier Saunders; 2014. p. 630–65. Print. 3. Thawrani DP, Feldman DS, Sala DA. Current practice in the management of slipped capital femoral epiphysis. J Pediatr Orthop. 2016;36(3):e27–37. 4. Aronsson DD, Loder RT, Breur GJ. Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg. 2006;14(12):666–79. Chapter 113 Congenital Hip Dislocation Jose M. Ramirez

What are risk factors for CHD? First born, breech, family history, female, oligohydramnios What is the Barlow exam Dislocation of flexed, adducted maneuver? femur with axial load What is the ortolani exam Reduction of dislocated hip maneuver? with flexion, elevation, and abduction What is a normal alpha angle? Greater than 60° What is the preferred treatment Pavlik harness of a reducible hip in a patient <6 months of age?

J. M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 259 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_113 Chapter 114 Congenital Coxa Vara Jose M. Ramirez

What is a normal femoral neck 125–135° shaft angle? What is Hilgenreiner’s angle? Angle formed between Hilgenreiner’s line and proximal femoral physis What surgery is typically Corrective valgus derotational indicated for Hilgenreiner osteotomy epiphyseal angle >60°?

J. M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 261 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_114 Chapter 115 Osteochondrosis (Osgood- Schlatter and Osteochondritis Dissecans) Jose M. Ramirez

What is the most common Capitellum location for OCD in the upper extremity of a young athlete? What is the most common Medial femoral condyle location for OCD of the knee? What is Sinding-Larsen Chronic apophysitis of inferior Johansson syndrome? pole of the patella What can be seen on Fragmentation of the tibial radiographs of the knee in tubercle Osgood-Schlatter’s disease? What is Iselin’s disease? Apophysitis of base of fifth metatarsal

J. M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 263 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_115 Chapter 116 Osteogenesis Imperfecta (OI) Jose M. Ramirez

OI is caused by a qualitative and/or Type 1 Collagen quantitative defect in what protein? What medical therapy can reduce Bisphosphonate fracture rate in OI? therapy Signs of myelopathy on exam should Basilar invagination raise concern for what complication associated with OI? What upper extremity fracture is Olecranon apophyseal pathognomonic for OI? avulsion fracture What lower extremity deformity Coxa Vara associated with OI can lead to a Trendelenburg gait?

J. M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 265 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_116 Chapter 117 Child Abuse Jose M. Ramirez

What is the chance of death 5–10% for a child who is a victim of unreported physical abuse? What is the classically reported Metaphyseal corner fractures location for concerning extremity fractures in child abuse? What elbow injury should raise Distal humerus physeal concern for child abuse? separation What is the most common Skin lesion presenting sign in an abused child? True/False: Physicians are legally True obligated to report cases of child abuse.

J. M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 267 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_117 Chapter 118 Legg-Calve-Perthes Disease Jose M. Ramirez

What are the Waldenström Initial, fragmentation, stages of Perthes disease? reossification, remodeling (healing) What is the crescent sign? Radiographically, a subchondral fracture of femoral head What syndrome should be in Multiple epiphyseal dysplasia the differential diagnosis of (MED) a patient suspected bilateral perthes disease? When does fragmentation Approximately 6 months after typically occur? the onset of symptoms

J. M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 269 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_118 Chapter 119 Cerebral Palsy Heather Hansen

What is the term used to Static encephalopathy describe the brain lesion in cerebral palsy? When does the brain insult Prenatally, perinatally, or during occur? childhood What is the time course Progressive of musculoskeletal pathology? What is the name of Gross Motor Function the most common Classification System (GMFCS) measurement of gross motor function? (continued)

H. Hansen, MD Division of Pediatric Orthopaedic Surgery, Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA

(continued) What are some risk factors Low birth weight/prematurity, for the development maternal infection, drug/ of CP? alcohol abuse, congenital brain malformation, perinatal anoxia, breech presentation, post-natal infections, or head trauma What is the main Tendon lengthening treatment option for a fixed musculotendinous contracture? What is responsible Muscle imbalance between for hip subluxation? spasticity and contracture of the adductors and flexors that overpower the weaker and noncontracted hip extensors and abductors What are the three surgical (1) soft tissue release for categories of treatment subluxation or a hip at risk, of a hip at risk of (2) reduction and reconstruction subluxation/dislocation? of the subluxated or dislocated hip, and (3) salvage surgery for long-standing painful dislocations What is the most common Scoliosis spine problem in cerebral palsy? What is the typical Long, sweeping, C-shaped appearance of a scoliosis curve?

Bibliography

1. Kerr Graham H, Thomason P, Novacheck TF. Cerebral palsy. In: Weinstein SL, editor. Lovell and Winter’s pediatric orthopaedics, vol. 1. 7th ed. Philadelphia: Wolters Kluwer; 2014. p. 486–554. Print. 119 Cerebral Palsy 273

2. Karol LA. Disorders of the brain. In: Herring JA, editor. Tachjian’s pediatric orthopaedics: from the Texas Scottish Rite Hospital, vol. 2. 5th ed. Philadelphia: Elsevier Saunders; 2014. p. 370–85. Print. 3. Refakis CA, Baldwin KD, Speigel DA, Sankar WN. Treatment of the dislocated hip in infants with spasticity. J Pediatr Orthop. 2016 [Epub ahead of print]. 4. Aversano MW, Sheikh Taha AM, Mundluru S, Otsuka NY. What’s new in the orthopedic treatment of cerebral palsy. J Pediatr Orthop. 2017;31(3):210–6. 5. McCarthy JJ, D’Andrea LP, Betz RR. Scoliosis in the child with cerebral palsy. J Am Acad Orthop Surg. 2006;14(6):367–75. 6. Karol LA. Surgical management of the lower extremity in ambu- latory children with cerebral palsy. J Am Acad Orthop Surg. 2004;12(3):196–203. Chapter 120 Spinal Bifida Daniel Brian Carlin Reid

Supplementation of what vitamin Folate can decrease risk of spina bifida? What lab test can be obtained in Alpha-fetoprotein (usually the second trimester to evaluate elevated in spina bifida) for spina bifida What is the most common Type II Arnold-Chiari comorbid condition with spina Malformation bifida? What allergy is common in Latex patients with spina bifida? Why is L4 considered a “key Important for quadriceps level” for function in patients function, allows some with spina bifida? independent community ambulation (continued)

D. B. C. Reid, MD, MPH Department of Orthopaedics, Rhode Island Hospital, Brown University, Providence, RI, USA

(continued) Rapid scoliosis curve progression Tethered cord and/or in patient’s with spina bifida hydrocephalus should raise concern for what? What should be ordered in X-rays (pathologic fractures patients with spina bifida common in myelodysplastic presenting with warm, red, children, often mistaken for swollen joints (other than infection) infectious workup)? Chapter 121 Charcot-Marie-Tooth Disease Heather Hansen and Seth W. O’Donnell

What is Charcot- Hereditary motor-sensory Marie-Tooth (CMT) neuropathy disease? What is the common Cavo-varus foot deformity seen with progressive CMT? What muscle Weak tibialis anterior is imbalances result from overpowered by peroneus longus; CMT? weak peroneus brevis is overpowered by tibialis posterior Other than the Hip dysplasia, scoliosis, wasting foot and ankle, of the hand intrinsic muscles what orthopedic manifestations of CMT may be present? (continued)

H. Hansen, MD (*) · S. W. O’Donnell, MD Division of Pediatric Orthopaedic Surgery, Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA © Springer International Publishing AG, part of Springer Nature 2018 277 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_121 278 H. Hansen and S. W. O’Donnell

(continued) What is often the first Plantar flexion of the first ray foot abnormality seen in CMT? What test can be used Coleman block test to assess the rigidity of a hindfoot deformity? What is a cavus foot? A pathologically high arch What does “equinus” The amount of plantar flexion at the describe? ankle; often due to a contracture of the Achilles tendon or gastroc-soleus complex What are diagnostic Nerve conduction studies, tests to perform to electromyography (EMG), and confirm diagnosis? genetic testing. Nerve biopsy provides definitive diagnosis but often isn’t necessary

Bibliography

1. Thompson GH, Berenson FR. Other neuromuscular disorders. In: Weinstein SL, editor. Lovell and Winter’s pediatric orthopaedics, vol. 2. 7th ed. Philadelphia: Wolters Kluwer; 2014. p. 610–5. Print. 2. Podeszwa DA. Disorders of the peripheral nervous system. In: Herring JA, editor. Tachjian’s pediatric orthopaedics: from the Texas Scottish Rite Hospital, vol. 2. 5th ed. Philadelphia: Elsevier Saunders; 2014. p. 285–97. Print. 3. Casare F, Francesco T, Matteo N, Antonio M, Carlotta C, Daniele F, Camilla P, Sandro G. Surgical treatment of cavus foot in Charcot- Marie-Tooth disease: a review of twenty-four cases: AAOS exhibit selection. J Bone Joint Surg Am. 2015;97(6):e30. 121 Charcot-Marie-Tooth Disease 279

4. Schwend Richard M, Drennan JC. Cavus foot deformity in children. J Am Acad Orthop Surg. 2003;11:201–11. 5. Nagai MK, Chan G, Guille JT, Kumar SJ, Scavina M, Mackenzie WG. Prevalence of Charcot-Marie-Tooth disease in patients who have bilateral cavovarus feet. J Pediatr Orthop. 2006;26(4):438–43. 6. Yagerman SE, Cross MB, Green DW, Scher DM. Pediatric orthopedic conditions in Charcot-Marie-Tooth disease: a literature review. Curr Opin Pediatr. 2012;24(1):50–60. Chapter 122 Muscular Dystrophy Jose M. Ramirez

What protein is defective Dystrophin in MD? What is the inheritance X-linked recessive pattern of MD? How does Becker’s MD Becker’s is related to a decrease differ from Duchenne’s in dystrophin MD? What is Gower’s sign? Rising by using arms to compensate for weakness or core muscles What foot abnormality Equinovarus foot is seen in MD?

J. M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 281 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_122 Chapter 123 Arthrogryposis Jonathan R. Schiller

What is the common Shoulder abdducted internally position of the upper rotated; elbow extended; wrist extremities? flexed with ulnar deviation What is the common Hips flexed abducted and position of the lower externally rotated; knees extremities? typically extended; clubfeet What type of clubfoot Rigid, requiring surgical release deformity is present in arthrogryposis? (continued)

J. R. Schiller, MD Adolescent and Young Adult Hip Program, Orthopaedic Surgery, The Warren Alpert School of Medicine of Brown University, Providence, RI, USA Division of Pediatric Orthopaedics and Scoliosis, Hasbro Children’s Hospital, Rhode Island Hospital, Providence, RI, USA Division of Sports Medicine, Hasbro Children’s Hospital, Rhode Island Hospital, Providence, RI, USA e-mail: [email protected]

(continued) What is the most C-shaped neuromuscular pattern common type of spine deformity? What is the inheritance Autosomal recessive pattern of arthrogryposis multiplex congenita? Chapter 124 Achondroplasia Heather Hansen

What is the most Achondroplasia common form of dwarfism? What zone of the growth Provisional calcification plate is affected? What gene is involved? Fibroblast growth factor 3 (FGFR3) What is the inheritance Autosomal dominant pattern? What appearance do Trident achondroplastic hands have? What appearance do the Genu varum knees typically have? (continued)

H. Hansen, MD Division of Pediatric Orthopaedic Surgery, Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA

(continued) What is the most Kyphosis at the thoracolumbar common spine junction deformity? What is the common Spinal stenosis spine problem requiring surgery? What is the common Foramen magnum stenosis skull abnormality with serious complications? What is the key Narrowing of the L1–L5 radiographic feature interpedicular distance on an AP lumbar spine radiograph?

Bibliography

1. Sponseller PD, Ain MC. The skeletal dysplasias. In: Weinstein SL, editor. Lovell and Winter’s pediatric orthopaedics, vol. 1. 7th ed. Philadelphia: Wolters Kluwer; 2014. p. 180–6. Print. 2. Herring JA. Skeletal dysplasias. In: Herring JA, editor. Tachjian’s pediatric orthopaedics: from the Texas Scottish Rite Hospital, vol. 2. 5th ed. Philadelphia: Elsevier Saunders; 2014. p. 370–85. Print. 3. Shirley ED, Ain MC. Achondroplasia: manifestations and treatment. J Am Acad Orthop Surg. 2009;17:231–41. Chapter 125 Other Skeletal Dysplasia Jonathan R. Schiller

What is the inheritance pattern Autosomal recessive of diastrophic dysplasia? Diastrophic dysplasia is a result Sulfate transport protein of what defect? What are the classic findings for Hitchhiker thumb and diastrophic dysplasia? cauliflower ears (continued)

(continued)

What gene defect is responsible RUNX 2 for cleidocranial dysplasia?

What bone is classically involved Clavicle in cleidocranial dysplasia? What is the genetic defect in Sox 9 campomelic dysplasia? What is the inheritance pattern Autosomal dominant of campomelic dysplasia? Chapter 126 Chromosomal and Inherited Syndromes Jose M. Ramirez

What is trisomy 21? Down syndrome What disease is associated Gaucher’s disease with a deficiency in B-glucocerebrosidase? What is the defective protein FGR3 receptor that leads to achondroplasia? What is VATER? Syndromic disorders associated with vertebral anomalies, anal atresia, tracheoesophageal fistula, esophageal atresia, and renal agenesis What is inheritance pattern Autosomal dominant of early onset Charcot- Marie-Tooth disease?

J. M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 289 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_126 Chapter 127 Arthritis Jose M. Ramirez

What are the radiographic Joint space narrowing, marginal signs of arthritis? osteophytes, subchondral sclerosis, periarticular cyst formation True or False: Water True content in collagen increases in osteoarthritis. What collagen type is Type II (2) most commonly found in articular cartilage? What are the layers of Superficial, intermediate, deep, articular cartilage? tidemark What kind of cartilage Fibrocartilage is formed as a result of an injury through the tidemark?

J. M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 291 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_127 Chapter 128 Shoulder and Elbow Deformities Aristides I. Cruz Jr.

What percentage of the 80% humerus’ longitudinal growth comes from the proximal physis? What is the gene abnormality RUNX2/CBFA1 associated with cleidocranial dysplasia? What form of ossification Intramembranous ossification accounts for ossification of the clavicle? At what age is brachial 5–6 months plexus birth palsy unlikely to spontaneously recover (i.e., if antigravity motor function is not displayed by age ____)? (continued)

A. I. Cruz Jr., MD, MBA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What trunk/nerve roots are Upper trunk/C5-C6 most commonly involved in brachial plexus birth palsy? What clinical manifestations Shoulder abduction/external occur with chronic, upper rotation weakness, internal trunk, brachial plexus birth rotation contracture, posterior palsy? glenoid deficiency/dysplasia What is Sprengel’s deformity? It is a congenital condition of the shoulder that results in an undescended scapula which can result in abnormal motion of the shoulder What is the most common Cubitus varus coronal plane deformity after a supracondylar humerus fracture malunion? What is the name of the Fishtail deformity deformity that can occur after a distal humerus lateral condyle non-union? What is Panner’s disease? Osteochondrosis of the capitellum What is “Little Leaguer’s Proximal humeral physiolysis Shoulder”? resulting from overuse in an overhead throwing athlete Avulsion fracture of the Osteogenesis imperfecta olecranon apophysis is associated with what condition? Chapter 129 Hand and Wrist Deformities Aristides I. Cruz Jr.

What is Madelung’s Distal radius congenital physeal deformity? abnormality that results in distal radial growth disturbance and resultant increased distal radial inclination and volar tilt What is “gymnast’s wrist”? Distal radial physeal repetitive stress syndrome What is the anatomic Post-axial = ulnar sided difference between post-axial duplication and pre-axial polydactyly? Pre-axial = radial sided duplication What is the primary goal To provide a functional and stable when surgically treating pre- thumb axial polydactyly? (continued)

A. I. Cruz Jr., MD, MBA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) At what age is pediatric Two years old trigger thumb unlikely to spontaneously resolve? What is the treatment for A1 pulley release pediatric trigger thumb that has failed to resolve spontaneously and has failed to respond to nonoperative treatment? What conditions are Thrombocytopenia absent radius associated with radial club (TAR) syndrome hand? Fanconi’s anemia Holt-Oram syndrome VACTERL syndrome VATER syndrome What is clinodactyly? Curvature of the digit in the radial-ulnar plane What is the inheritance Autosomal dominant pattern in clinodactyly? What is the hand “Rosebud hand” abnormality associated with Apert syndrome? What is Streeter’s syndrome? Amniotic band (constriction band) syndrome What is the difference Simple = soft tissue involvement between complex and simple only syndactyly? Complex = bony synostosis What classification scheme is Wassel classification commonly used to describe thumb duplications? Chapter 130 Genu Varum Aristides I. Cruz Jr.

What is the name of the Blount’s disease condition describing pathologic proximal tibia vara? What medical conditions Rickets, osteogenesis imperfecta, can lead to pathologic multiple epiphyseal dysplasia (MED), genu varum? spondyloepiphyseal dysplasia (SED), achondroplasia, pseudoachondroplasia What are the risk factors Early walking, obesity, African- for pathologic tibia vara American descent (Blount’s disease)? (continued)

A. I. Cruz Jr., MD, MBA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) Which compartment Medial compartment of the knee does the mechanical axis pass through in patients with genu varum? What is the name of Langenskiöld classification the classification system commonly used to describe pathologic tibia vara? Chapter 131 Genu Valgum Aristides I. Cruz Jr.

What is the normal amount of About 5–7° valgus (in degrees) at skeletal maturity? At what age is genu valgum Age 3–4 years most pronounced? At what age is persistent Older than 7 years or worsening genu valgum considered pathologic? What is “miserable Excess femoral anteversion malalignment”? combined with excess external tibial torsion (continued)

A. I. Cruz Jr., MD, MBA Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What is Cozen’s fracture? Proximal tibial metaphyseal fracture which is associated with the development of late valgus deformity which usually resolves spontaneously

What is the treatment of choice Temporary hemi-epiphysiodesis for pathologic genu valgum in or “guided-growth” skeletally immature patients? Which X-ray should be ordered Bilateral, standing AP long-leg to diagnose and monitor genu valgum? What anatomic structure is at Peroneal nerve risk if performing a proximal tibia lateral opening wedge osteotomy to correct excess proximal tibia valgus? What is the normal range for mLFDA = 87° (85–90°) the mechanical lateral distal MPTA = 87° (85–90°) femoral angle (mLDFA) and medial proximal tibial angle (MPTA)? Which compartment of the knee Lateral compartment does the mechanical axis pass through in patients with genu valgum? Chapter 132 Axial Rotations Jose M. Ramirez

What is the most common Internal tibial torsion cause of intoeing in toddlers? How does one measure With the patient prone, angle formed thigh foot angle? along middle of the foot and the ipsilateral thigh What are two additional Metatarsus adductus, femoral causes of intoeing in anteversion children?

J. M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 301 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_132 Chapter 133 Limb Deficiency Jose M. Ramirez

What is the expected yearly contribution 9 mm per year/6 mm to longitudinal growth of the distal per year femoral physis/proximal tibial physis? What is the expected yearly contribution 6 mm per year to longitudinal growth of the proximal tibial physis? What is the preferred management Observation and/or of a patient with a 2 cm leg length shoe lift discrepancy? How is a 2–5 cm leg length discrepancy Epiphysiodesis of the typically addressed surgically? longer extremity

J. M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 303 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_133 Chapter 134 Limb Length Discrepancy Jonathan R. Schiller

A limb length discrepancy Congenital (hemihypertrophy), (LLD) can be classified into dysplastic (hemimelia), acquired what three groups? (trauma, tumor, infection) What is the gold standard Radiographic assessment for accurate limb length with limb length radiograph, measurement? scanogram, CT scanogram, EOS imaging

What is the average yearly 9 mm, 6 mm respectively growth of the distal femoral physis and proximal tibia physis? (continued)

J. R. Schiller, MD Adolescent and Young Adult Hip Program, The Warren Alpert School of Medicine of Brown University, Providence, RI, USA Division of Pediatric Orthopaedics and Scoliosis, Hasbro Children’s Hospital, Rhode Island Hospital, Providence, RI, USA Division of Sports Medicine, Hasbro Children’s Hospital, Rhode Island Hospital, Providence, RI, USA e-mail: [email protected]

(continued) Surgery is indicated for a Greater than 2.5 cm discrepancy of how much? What is the treatment for Amputation and prosthetic discrepancies greater than fitting 20 cm? Accurate assessment for Bone age surgical timing requires what radiologic image study? Limb length discrepancies Contralateral epiphysiodesis greater than 5 cm consists of with lengthening using external what surgical treatment? fixator or intramedullary device Chapter 135 Pseudarthrosis of the Tibia Jonathan R. Schiller

What type of bowing occurs in Anterolateral congenital pseudoarthrosis of the tibia? Congenital pseudarthrosis of Neurofibromatosis type 1, the tibia is associated with what 50% underlying pathology? What is the goal of treatment for To prevent fracture anterolateral bowing of the tibia? What is the treatment for Bracing anterolateral bowing to prevent fracture? (continued) J. R. Schiller, MD Adolescent and Young Adult Hip Program, The Warren Alpert School of Medicine of Brown University, Providence, RI, USA Division of Pediatric Orthopaedics and Scoliosis, Hasbro Children’s Hospital, Rhode Island Hospital, Providence, RI, USA Division of Sports Medicine, Hasbro Children’s Hospital, Rhode Island Hospital, Providence, RI, USA e-mail: [email protected]

(continued) What is the treatment for fracture Operative fixation with of the anterolateral bowing of the Ilizarov or intramedullary tibia? fixation Failure to achieve union in a Below-knee amputation pseudarthrosis of the tibia may require what procedure? Chapter 136 Foot and Ankle Deformities Jonathan R. Schiller

What are the characteristics Rigid rocker bottom deformity, of a congenital vertical talus fixed dorsal dislocation of (CVT)? talonavicular joint What neuromuscular disorder Myelomeningocele is often associated with CVT? What test is diagnostic for Forced plantar flexion on lateral CVT? radiograph of foot What is the most common Clubfoot congenital foot disorder? (continued)

(continued) What are the characteristics of Midfoot cavus, forefoot a clubfoot? adductus, hindfoot varus, and equinus What is the gold standard of Ponseti casting clubfoot treatment? What is the order of correction CAVE; cavus, adductus, varus, for a clubfoot using the Ponseti equinus casting method? What is a bean-shaped foot Metatarsus adductus deformity otherwise known as? What is the primary treatment Observation/stretching of metatarsus adductus? What is a tarsal coalition? Abnormal connection between two bones in the midfoot or hindfoot What types of coalitions can Osseous, cartilaginous, or fibrous occur? A coalition is often present Rigid flat foot with minimal with what type of foot? subtalar motion What imaging study is CT scan preferred for the diagnosis of a tarsal coalition? What are the two most Calcaneal navicular, common coalitions? talocalcaneal What characterizes a cavovarus Elevated medial arch, plantar foot? flexion of the first ray, hindfoot varus This deformity is often Charcot-Marie-Tooth disease, associated with what tethered cord neuromuscular or spinal cord problems? What test is used to distinguish Coleman block test a flexible hindfoot? Hindfoot varus is driven by Forefoot plantar flexion of the what deformity? first ray Chapter 137 Idiopathic Scoliosis Daniel Brian Carlin Reid

Which is more Right thoracic curve common: right or left thoracic curve? Define the Cobb On PA radiograph: angle of intersection angle. between a line drawn parallel to the superior endplate of the superior end vertebra and a line parallel to the inferior endplate of the inferior end vertebra of a curve deformity Name indications for Atypical curve pattern (e.g., left thoracic MRI scan prior to curve), rapid curve progression, painful operative treatment scoliosis, neurologic signs/symptoms, of patients with asymmetric abdominal reflex, apical scoliosis. kyphosis of the thoracic curve, juvenile- onset scoliosis, associated syndrome, or congenital abnormalities (continued)

D. B. C. Reid, MD, MPH Department of Orthopaedics, Rhode Island Hospital, Brown University, Providence, RI, USA

(continued) What are the <25°: observation, 25–45°: bracing, >45– commonly cited Cobb 50°: operative treatment angle cutoffs for different idiopathic scoliosis treatment modalities? What is the goal of To stop or slow curve progression bracing? What is the unique Crankshaft phenomenon (anterior spine risk of posterior continues to grow after posterior fusion, fusion alone in increasing rotation/deformity) skeletally immature patients? Chapter 138 Neuromuscular Scoliosis Daniel Brian Carlin Reid

Name some major ways More rapidly progressive, can in which neuromuscular progress after skeletal maturity, scoliosis is different than associated with pelvic obliquity, idiopathic often longer curves involving more vertebrae, higher rate of pulmonary complications In general, has bracing No generally been proven to improve deformity or slow progression of disease in patients with neuromuscular scoliosis? (continued)

D. B. C. Reid, MD, MPH Department of Orthopaedics, Rhode Island Hospital, Brown University, Providence, RI, USA

(continued) Name common underlying Cerebral palsy, Rett syndrome, conditions resulting in muscular dystrophy, Friedreich’s neuromuscular scoliosis Ataxia, spina bifida, spinal muscular atrophy, neurofibromatosis, arthrogryposis, polio, traumatic paralysis Why is nutritional status Poor nutritional status is important to the orthopedic associated with increased overall surgeon treating patients complications (infection, longer with neuromuscular intubations, longer hospital stays, scoliosis? etc.) What nutritional markers Albumin <3.5 g/dL, WBC have been associated <1500 Leukocytes/μL with increased wound complications? Chapter 139 Congenital Spinal Anomalies Daniel Brian Carlin Reid

Congenital scoliosis is Fourth–sixth week of gestation generally caused by an error in normal fetal development during what time period? What is the most common Spontaneous inheritance pattern of congenital scoliosis? Name some known Alcohol, valproic acid, maternal exposures hyperthermia, diabetes associated with congenital scoliosis What is VACTERL Known association between association? vertebral anomolies, anal atresia, cardiac anomolies, tracheoesophageal fistula, renal anomalies, and limb defects (continued)

D. B. C. Reid, MD, MPH Department of Orthopaedics, Rhode Island Hospital, Brown University, Providence, RI, USA

(continued) Which patients with All patients, to evaluate for congenital scoliosis require intraspinal abnormalities MRI before surgery? What are the three Failure of formation, failure of basic types of defects in segmentation, mixed congenital scoliosis? What congenital defect Block vertebrae confers the lowest risk of progression of congenital scoliosis? What congenital defect Unilateral unsegmented bar with confers the highest risk of contralateral hemivertebrae progression of congenital scoliosis? Chapter 140 Scheuermann’s Kyphosis Daniel Brian Carlin Reid

What is considered normal 20–45° range for thoracic kyphosis? How is Scheuermann’s Rigid thoracic kyphosis >45° with kyphosis defined? >5° anterior wedging at three consecutive vertebrae Does Scheurmann’s kyphosis No correct to normal with hyperextension? What are other common Compensatory lumbar radiographic findings in hyperlordosis, spondylolysis, patients with Scheurmann’s scoliosis, disc space narrowing, kyphosis? end plate changes, Schmorl nodes What degree of kyphosis is >75° often cited as an indication for surgery?

D. B. C. Reid, MD, MPH Department of Orthopaedics, Rhode Island Hospital, Brown University, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 317 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_140 Chapter 141 Cervical Spine Disorders (Pediatric) Daniel Brian Carlin Reid

What pediatric syndrome is Klippel-Feil syndrome characterized by abnormalities in multiple cervical segments caused by failure of normal segmentation? Why do patients with trisomy 21 often To evaluate for get cervical spine flexion-extension atlantoaxial instability views prior to elective surgery? prior to intubation What study is considered the gold Dynamic CT standard for diagnosing rotary atlantoaxial subluxation? What is the name of the condition in Grisel’s disease which a patient is diagnosed with rotary atlantoaxial subluxation after recent retropharyngeal abscess or respiratory infection? (continued)

D. B. C. Reid, MD, MPH Department of Orthopaedics, Rhode Island Hospital, Brown University, Providence, RI, USA

(continued) What structure limits anterior translation Transverse ligament of C1 (atlas) on C2 (axis)? What anatomic variant of C2 is often Os odontoideum mistaken for an odontoid fracture? What study can help differentiate Flexion- pediatric cervical spine extension X-rays pseudosubluxation from true injury? (pseudosubluxaton will reduce on extension films) What is it called when the odontoid Basilar invagination migrates into the foramen magnum, potentially impinging on the brainstem? What advanced imaging study can CT myelogram be used to indirectly visualize neural elements and/or spinal cord compression in patients who cannot undergo an MRI Chapter 142 Spondylolysis and Spondylolisthesis Daniel Brian Carlin Reid

Spondylolysis refers to a defect Pars interarticularis or fracture of which structure? How is spondylolisthesis Anterior translation of one defined? vertebra on the vertebra below it (most commonly L5 on S1) What is spondyloptosis? Greater than 100% slip of one vertebral body on the once below it (Meyerding Grade 5 slip) Which X-ray views show the Oblique radiographs “scottie dog”? What type of spondylolisthesis is Isthmic most common in adolescents? (continued)

D. B. C. Reid, MD, MPH Department of Orthopaedics, Rhode Island Hospital, Brown University, Providence, RI, USA

(continued) What nerve root is most L5 commonly affected by L5-S1 isthmic spondylolisthesis? What is the main structure at L5 nerve root risk with attempted reduction of L5-S1 spondylolisthesis? Chapter 143 Spine Injuries Daniel Brian Carlin Reid

What physical exam finding Return of bulbocavernosus reflex signals the end of spinal shock? What vital sign is most Pulse (neurogenic shock results in helpful in differentiation relative bradycardia in setting of neurogenic shock from hypotension) hypovolemic shock? How does the American The most caudal segment of spinal injury association spinal cord with normal sensory (ASIA) classification define and at least 3/5 (antigravity) the neurologic level of injury? motor function on both sides of the body Why are cervical spine Large head-to-body-ratio injuries more common in children <8 years old? (continued)

D. B. C. Reid, MD, MPH Department of Orthopaedics, Rhode Island Hospital, Brown University, Providence, RI, USA

(continued) What three X-ray views are Anteroposterior (AP), lateral, most commonly used to open-mouth odontoid evaluate the cervical spine in pediatric patients following trauma? Where do odontoid fractures Through the synchondrosis commonly occur in children? (Salter-Harris type 1 injury) Part VI Systemic Conditions

325 Chapter 144 Septic Arthritis Stephen Marcaccio

Define septic A serious orthopedic condition arthritis. characterized by infection of synovial joints resulting in rapid destruction of articular cartilage What are three 1. Bacteremia mechanisms of joint 2. Direct inoculation infection? 3. Contiguous spread (adjacent osteomyelitis) What organism is the Staph aureus most common cause of septic arthritis? What is the classic Young sexually active adolescents presentation for and young adults Neisseria septic arthritis? (continued)

S. Marcaccio, MD Department of Orthopaedic Surgery, Rhode Island Hospital, Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What types of IV drug users patients typically present with SC joint infections? How do patients Pain in joint area, fevers (60% cases), joint usually present with resting in position that allows maximum septic arthritis? joint volume (FABER for hip). Warm and tender to the touch, inability to bear weight, no ROM What is the classic ESR, CRP, WBC, aspirate the joint fluid workup for suspected septic arthritis? What is the definitive This is an orthopedic emergency: IV abx, treatment for septic operative irrigation and debridement and arthritis? drainage of the joint is essential Chapter 145 Osteomyelitis Adam Driesman

What is the most common Staph aureus organism found in osteomyelitis of adults? What is the most common Still Staph aureus, while Salmonella organism found in species is pathognomonic sickle cell patients with osteomyelitis? What is the most Hematogenous seeding, typically to common transmission the metaphyseal region of osteomyelitis in the pediatric population? (continued)

A. Driesman, MD Department of Orthopaedics, NYU Hospital for Joint Diseases, New York, NY, USA Drs. Ramirez and Terek are at associated with Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the name of a Cierny and Mader classification common classification scheme for chronic osteomyelitis? What are the four stages Stage 1: Medullary of this classification Stage 2: Superficial to describe anatomic Stage 3: Localized location? Stage 4: Diffuse What are the three types Type A: Normal of this classification to Type B: Compromised describe the patient’s Type C: Treatment is worse to immune status? patient than infection What is a sequestrum? Necrotic bone that can serve as a source for infection in chronic osteomyelitis. It is typically sclerotic and avascular, thereby limiting antibiotic penetration What is the name of new Involucrum bone formation that occurs as a periosteal reaction to chronic osteomyelitis? What inflammatory ESR and CRP markers are elevated in WBC is only elevated in 35% of chronic osteomyelitis? cases What is the gold standard Biopsy specimen for evaluation of in diagnosis? histology and microbiology Formation of what makes Biofilm peri-implant infection difficult to treat? Chapter 146 Necrotizing Fasciitis Adam Driesman

What is the predominant Non-group A streptococci bacteria that causes necrotizing fasciitis? What are more common, Polymicrobial infections monomicrobial or polymicrobial infections? What patient risk factors Immunosuppressed (AIDS/chemo), predispose patients to DM, PVD, alcoholism, IV drug use necrotizing fasciitis? What is the typical clinical Rapid progression that requires course of this infection? emergent treatment (continued)

A. Driesman, MD Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA Drs. Ramirez and Terek are at associated with Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What are some of the Skin abscess, bullae, blue clinical physical exam discoloration, pain, swelling, non- signs? pitting edema In comparison, gas gangrene typically described as pus that is “dish-water soap” like appearance What is the main origin of Minimal trauma or minor skin infection? lesions Note: can still occur in the absence of trauma What is the mainstay of Early surgical debridement and treatment? wide-spectrum antibiotic therapy What is the mortality rate Upwards of 30% found in these patients? Chapter 147 Osteoarthritis Sean Esmende and Hardeep Singh

What are the primary 1. Extracellular matrix (90% components of articular collagen and proteoglycan) (hyaline) cartilage? 2. Chondrocytes 3. Water How does water content differ Water decreases with normal between normal aging and aging and decreases with osteoarthritis? osteoarthritis What are the zones of articular 1. Superficial zone cartilage? 2. Intermediate zone 3. Deep (basal) later 4. Tidemark 5. Subchondral bone (continued)

S. Esmende, MD (*) Orthopedic Associates of Hartford, Division of Spine Surgery, The Bone and Joint Institute, Hartford Hospital, Hartford, CT, USA H. Singh, MD Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut School of Medicine, Farmington, CT, USA

© Springer International Publishing AG, part of Springer Nature 2018 333 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_147 334 S. Esmende and H. Singh

(continued) What effect does immobilization Leads to cartilage thinning and have on cartilage? proteoglycan loss With aging, what happens to – Increase in chondrocyte size chondrocyte size and the ratio – Increase in keratin sulfate to of keratin sulfate to chondroitin chondroitin sulfate sulfate? What effect does moderate Moderate running increases repetitive loading have on cartilage thickness and cartilage and proteoglycans? proteoglycan content How is cartilage nourished? – Synovial fluid at the cartilage surface – Subchondral bone at the base What are the different forms of 1. Elastohydrodynamic lubrication? 2. Boundary (slippery surface) 3. Boosted (fluid entrapment) 4. Hydrodynamic 5. Weeping What is the difference in – Deep laceration leads to cartilage healing between a fibrocartilage healing deep and superficial laceration? – Superficial laceration leads to chondrocyte proliferation with NO healing Chapter 148 Rheumatoid Arthritis Stuart T. Schwartz

What is the inflammatory erosive The pannus synovial tissue in rheumatoid arthritis? Name two hand deformities in Swan neck and rheumatoid arthritis. boutonniere deformities Which joints in the hands are spared DIP joints from synovitis in rheumatoid arthritis? What condition should be excluded C1–C2 subluxation before surgical intubation in rheumatoid arthritis patients? What are two diagnostic serologies Rheumatoid factor and found in rheumatoid arthritis? anti-cyclic citrullinated peptide antibodies (continued)

S. T. Schwartz, MD Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What is the name of the syndrome Felty’s syndrome in patients with rheumatoid arthritis associated with splenomegaly and leukopenia (specifically, neutropenia)? What is the name of subcutaneous Rheumatoid nodules nodules found on the extensor surfaces and hands of patients with rheumatoid arthritis? Chapter 149 Crystal-Induced Arthropathy James Levins

What type of birefringence are Negative, yellow when parallel gout crystals? to direction of polarization, needle-shaped What is the mainstay of medical NSAIDs or colchicine, if treatment for an acute gout chronic kidney disease (CKD) attack? then steroids What surgical emergency has Septic arthritis—patients with to be in your differential for an crystalline arthropathy are also acute gout attack? at increased risk for developing septic arthritis What is the typical white blood 2000–50,000 WBC, neutrophil cell (WBC) range in crystalline predominant arthropathy? (continued)

J. Levins, MD Department of Orthopaedic Surgery, Brown University, Providence, RI, USA

(continued) In patients with calcium Chondrocalcinosis pyrophosphate deposition (calcification of cartilage) disease (pseudogout), what is a common finding on radiographs of the affected joint? Chapter 150 Fibromyalgia Deepan Dalal and Pieusha Malhotra

What are the Diffuse pain, fatigue, lack of refreshing cardinal symptoms of sleep, cognitive symptoms (memory, fibromyalgia? concentration) Who is typically Younger (20–55 years) female affected by fibromyalgia? What is the Amplified pain perception resulting from pathophysiology of central sensitization fibromyalgia? (continued)

D. Dalal, MD, MPH (*) Department of Medicine-Rheumatology, Brown University, Providence, RI, USA P. Malhotra, MD, MPH Department of Medicine-Rheumatology, Roger Williams Medical Center, Providence, RI, USA

© Springer International Publishing AG, part of Springer Nature 2018 339 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_150 340 D. Dalal and P. Malhotra

(continued) What are the Symptoms of irritable bowel syndrome, commonly associated interstitial cystitis, headaches/migraines, symptoms with premenstrual syndrome, depression/ fibromyalgia? anxiety, and host of other somatic manifestations What tests are Clinical diagnosis, inflammatory markers performed for are normal, serologies (RF, ANA) are diagnosis of often unremarkable fibromyalgia? In addition to the Primary sleep disorders like sleep apnea, above, what diseases restless leg syndrome should be ruled out? What are the non- (1) Aerobic exercise, (2) Cognitive pharmacologic behavioral therapy, (3) Evaluation of interventions for and correction of sleep disorders (CPAP fibromyalgia? machine, etc.) and (4) Complementary/ alternative medicine (yoga, Tai-chi, acupuncture) What are the Initial therapy with Amitriptyline (or drugs approved even Cyclobenzaprine) followed by for treatment of Duloxetine/Milnacipran/Gabapentin. fibromyalgia? Other drugs to consider acetaminophen, tramadol, and SSRIs. NSAIDs do not work very well Chapter 151 Seronegative Spondyloarthropathies Eren O. Kuris

What are seronegative Systemic rheumatologic spondyloarthropathies? disorders of the axial skeleton Why are they considered to be Because blood tests are seronegative? traditionally negative for rheumatoid factor, which is a marker that can detect many rheumatological conditions What are some common Ankylosing spondylitis examples of seronegative Reactive arthritis spondyloarthropathies? Psoriatic arthritis Juvenile idiopathic arthritis Enteropathic arthritis (continued)

E. O. Kuris, MD Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

(continued) What genetic marker is Human Leukocyte Antigen B27 frequently associated (HLA-B27) with seronegative spondyloarthropathies? What are some common Sacroiliitis manifestations of these Uveitis conditions? Inflammatory joint arthritis Enthesitis What radiographic spine Calcifications of the features are associated with intervertebral discs and ankylosing spondylitis? ligamentous complexes (syndesmophytes) Ankylosis of the facet joints (“bamboo spine”) What is the gold standard for Biologic drugs, such as disease- treatment of these conditions? modifying antirheumatic drugs (DMARDs) For example, antitumor necrosis factor-α inhibitors

Suggested Reading

1. Herkowitz HN, Garfin SR, Eismont FJ, Bel GR, Balderston RA. Rothman-Simeone The spine. 6th ed. Philadelphia, PA: Saunders; 2011 2. Khalessi AA, Oh BC, Wang MY. Medical management of ankylosing spondylitis. Neurosurg Focus. 2008;24(1):E4. https:// doi.org/10.3171/FOC/2008/24/1/E4. Review. PubMed PMID: 18290742. 3. Kubiak EN, Moskovich R, Errico TJ, Di Cesare PE. Orthopaedic management of ankylosing spondylitis. J Am Acad Orthop Surg. 2005;13(4):267–78. PubMed PMID: 16112983. Chapter 152 Polymyalgia Rheumatica Tina Brar and Joanne Szczygiel Cunha

What are the Pain and stiffness in the proximal muscles symptoms of of the shoulders and/or pelvic girdle polymyalgia rheumatica (PMR)? Which population Patients aged > 50 years, with average age does PMR affect? of onset of about 70 years. Caucasians are largely affected with a female predominance What are the usual Elevated erythrocyte sedimentation laboratory findings? rate (ESR), often >100 mm/h is the characteristic laboratory finding. But can occur with normal or mildly elevated ESR (>40 mm/h). C-reactive protein (CRP) is also usually elevated (continued)

T. Brar, MD (*) · J. S. Cunha, MD Division of Rheumatology, The Warren Alpert School of Medicine of Brown University, Providence, RI, USA e-mail: [email protected]

© Springer International Publishing AG, part of Springer Nature 2018 343 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_152 344 T. Brar and J. S. Cunha

(continued) What other Giant cell arteritis (GCA). In patients with rheumatologic PMR, giant cell arteritis may occur in 30% disease is PMR of these patients. While in patients with related to? GCA, polymyalgia rheumatica may occur in 40–60% of these individuals What are some New onset headache, jaw claudication, symptoms of giant scalp tenderness, and visual changes (i.e., cell arteritis? vision loss) What is the main Oral glucocorticoids. Prednisone is usually treatment of PMR? given at starting doses of 10–20 mg per day. Usually rapid improvement in patients’ symptoms is seen in 1–2 days What is the usually Steroids are slowly tapered over months to course of PMR? year(s) based on patient’s clinical response What is the Higher doses of steroids should be started treatment for immediately especially in patients with suspected giant cell progressive symptoms or visual loss arteritis? Chapter 153 Osteoporosis James Levins

What T-score is diagnostic for Less than −2.5 osteoporosis? How do bisphosphonates Increase osteoclast apoptosis, work? which inhibits bone resorption Why is it recommended Increased incidence of atypical that patients stop taking subtrochanteric fracture bisphosphonates after 5 years? What are the radiographic Lateral cortical thickening, findings of an atypical medial spike, transverse fracture bisphosphonate line subtrochanteric fracture? (continued)

J. Levins, MD Department of Orthopaedic Surgery, Brown University, Providence, RI, USA

(continued) What are the most common Vertebral compression fracture, fragility fractures? hip fracture (intertrochanteric or femoral neck), distal radius fracture, proximal humerus fracture Are locking or nonlocking Locking plates—secondary to plates typically used in poor cortical bone stock, locking osteoporotic bone? plates provide a more rigid construct to augment fixation In the general population of Approximately 20–30%, with those age > 60 years old, what rates up to 50% in high-risk is the 1-year mortality after a populations [1] low-energy hip fracture?

References

1. Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil. 2010;1(1):6–14. https://doi.org/10.1177/2151458510378105. Chapter 154 Rickets and Osteomalacia Review Jeanne Delgado

Without mineralization due to Cartilage, bone low calcium, ossification of ___ to ___ fails At the end of long bones, these Epiphyseal growth plates are open with rickets, but closed in those with osteomalacia Deficiency in any of these Calcium, vitamin D, phosphate three can cause rickets or osteomalacia. Which organ converts Kidney vitamin D into its active form

1–25(OH)2? Vitamin D (increases/ Increases, increases decreases) Ca2+ and (increases/ 3− decreases) PO4 (continued)

J. Delgado, MD Children’s National Medical Center, Washington, DC, USA

(continued) Parathyroid hormone Increases, decreases (increases/decreases) Ca2+ and 3− (increases/decreases) PO4 What are the top risk factors Breastfeeding without vitamin for rickets? supplementation, darkly pigmented skin, cities in northern latitude Characteristic of rickets, Chest X-ray rachitic rosary is often seen on which radiographic study? Rickets can cause what spinal Scoliosis, kyphosis, lordosis abnormalities? With rickets, which portion of Metaphyses long bone appears widened, cupped, frayed, or even invisible on radiograph? What is often the first clinical Acute fracture presentation of osteomalacia? Name other subtle symptoms of Low back pain, bone pain, osteomalacia. muscle pain, hypotonia Chapter 155 Chronic Kidney Disease- Mineral and Bone Disorder: “Renal Osteodystrophy” Janake Patel and Laura Amorese-O’Connell

What are the three 1. Disorders of calcium, components of CKD-MBD? phosphorous, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), and vitamin D metabolism 2. Derangements of bone turnover, mineralization, volume linear growth, or strength 3. Extraskeletal calcification (continued)

J. Patel, MD Roger William Medical Center, Boston University, Boston, MA, USA L. Amorese-O’Connell, MD (*) The Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: laura.amorese-o’[email protected]

© Springer International Publishing AG, part of Springer Nature 2018 349 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_155 350 J. Patel and L. Amorese-O’Connell

(continued) What is “renal Term exclusive for bone osteodystrophy”? morphology derangements associated to chronic kidney disease What are the systems involved Kidney, bone, intestine, and in the pathophysiology of vasculature CKD-MBD? What is the glomerular 40 mL/min or below filtration rate (GFR) at which most components of CKD- MBD are already present? What is the earliest stage of CKD stage 2 (estimated GFR chronic kidney disease at 60–89 mL/min/1.73 m2) which bone disease can be observed? What is a major feature of Secondary hyperparathyroidism CKD-MBD? What is secondary Persistently increased PTH hyperparathyroidism? secondary to: Increased phosphate and FGF23 concentration in serum Decreased calcium and vitamin D (calcitriol) level in serum Reduced vitamin D receptors, calcium-sensing receptors, fibroblast growth factor receptors, and Klotho in parathyroid gland cells What is the intervention for Bone biopsy definitive diagnosis of “renal osteodystrophy”? Chapter 156 Paget’s Disease of the Bone Janake Patel and Laura Amorese-O’Connell

What is the most common Asymptomatic disease with clinical presentation of Paget’s incidental finding of elevated disease of the bone (PDB)? serum alkaline phosphatase of bone origin What is the most common Bone pain symptom of Paget’s disease? What is the typical atraumatic Transverse or “Chalk-stick” fracture of long bone in Paget’s (not spiral) fracture patients? What type of bone lesions are Osteolytic, osteoblastic, and seen on plain radiographs? mixed lesions (continued)

J. Patel, MD Roger William Medical Center, Boston University, Providence, RI, USA L. Amorese-O’Connell, MD (*) The Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: laura.amorese-o’[email protected]

© Springer International Publishing AG, part of Springer Nature 2018 351 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_156 352 J. Patel and L. Amorese-O’Connell

(continued) What is the treatment of choice Bisphosphonates for Paget’s disease of the bone? How many weeks do you treat Minimum 6 weeks in an individual with PDB before scheduled orthopedic surgery? What is the most commonly Pelvis involved joint in monostatic (single site) disease? What causes excessive bleeding Highly vascular stromal tissue during orthopedic surgery in replacing normal bone marrow patients with Paget’s disease of the bone? What other imaging modality Bone scan besides plain films can be utilized for the diagnoses of Paget’s disease of the bone? What is the most common Deafness neurologic complication of Paget’s? Chapter 157 Systemic Lupus Erythematosus Tina Brar and Joanne Szczygiel Cunha

What is systemic lupus Chronic disease characterized erythematosus (SLE)? by immune system dysfunction leading to autoantibody formation and immune complex deposition causing organ injury SLE predominantly affects Women of child-bearing age which population? (15–45 years), more commonly affecting non-Caucasian persons What is the most common Anti-nuclear antigen (ANA), antibody found in SLE? seen in >95% of SLE patients Which antibodies are highly Anti-double-stranded DNA specific for renal disease? antibody (anti-dsDNA) and anti-Sm antibodies (continued)

T. Brar, MD (*) · J. S. Cunha, MD Division of Rheumatology, The Warren Alpert School of Medicine of Brown University, Providence, RI, USA e-mail: [email protected]

© Springer International Publishing AG, part of Springer Nature 2018 353 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_157 354 T. Brar and J. S. Cunha

(continued) In pregnant SLE patients, Anti-SSa (Rho) and anti-SSb which maternal antibodies (La) can help identify pregnancies at risk for neonatal lupus syndrome? What is the antibody that is Anti-histone antibody associated with drug-induced lupus, which is reversible on stopping the offending medication? What is the most characteristic Malar rash—erythematous rash lupus rash? over the malar prominences and nasal bridge that spares the nasolabial folds Which antibodies can help Antiphospholipid antibodies: identify SLE patients at risk Lupus anticoagulant, anti-β2 for a hypercoagulable state? glycoprotein-I, and anti- cardiolipin antibodies SLE patients have a variable, Corticosteroids, typically oral relapsing-remitting course; doses but higher intravenous acute flares of the disease doses are used in severe, life- and severe life-threatening threatening situations complications need to be treated with? Which medication is the Hydroxychloroquine cornerstone of SLE therapy, which helps reduce flares and prevent organ damage, decreases thrombosis risk, and improves survival of patients? Chapter 158 Osteonecrosis Deepan Dalal and Pieusha Malhotra

Which drugs are most Glucocorticoids and alcohol commonly associated with osteonecrosis? Which medical Trauma, lupus, antiphospholipid condition increases syndrome, decompression sickness, the risk of getting sickle cell disease, Gaucher’s disease osteonecrosis? Which is the most Femoral head, femoral condyles, tibial common site of plateaus, small bones of hand and foot osteonecrosis? (continued)

© Springer International Publishing AG, part of Springer Nature 2018 355 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_158 356 D. Dalal and P. Malhotra

(continued) Which is the most MRI (Other tests used—Tc-99 Bone sensitive test to scan) diagnose symptomatic osteonecrosis? What is the Crescent sign pathognomonic sign on X-ray? What is the differential Consider diagnosis of primary bone diagnosis of marrow edema syndrome—also called osteonecrosis? transient osteoporosis of hip (TOH), spontaneous osteonecrosis of knee (SONK), (causalgia, reflex sympathetic dystrophy, complex regional pain syndrome) [better evaluated with bone scan] Besides pain control Bisphosphonates, statins, anticoagulants, and reduction of weight and vasodilators like iloprost bearing, what other drugs can be considered for osteonecrosis? What are the surgical Core decompression, bone graft, treatment options? osteotomy, and joint replacement Chapter 159 Benign Bone Tumors Jose M. Ramirez, Adam Driesman, and Richard Terek

What population is Young males in the second or third most likely to form decade of life? an osteoid osteoma? What is the typical Pain that is worse at night. Pain will presentation of an improve with use of NSAIDs osteoid osteoma? (continued)

J. M. Ramirez, MD (*) Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA A. Driesman, MD Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA Drs. Ramirez and Terek are at associated with Brown University, Providence, RI, USA e-mail: [email protected] R. Terek, MD Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

© Springer International Publishing AG, part of Springer Nature 2018 357 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_159 358 J. M. Ramirez et al.

(continued) Why are NSAIDs Cyclooxygenases and prostaglandin E2 effective in is elevated by this benign bone mass. treatment? NSAIDs will reduce these levels What are Cortical radiolucent nidus <1.5 cm characteristic findings surrounded by reactive bone ofradiographs? What is needed to Plain radiographs are typically diagnostic make diagnosis of an with biopsy rarely needed to confirm osteoid osteoma? What is the most Osteochondroma common benign bone tumor? What disease is Multiple hereditary exostosis (MHE) the most common benign bone tumor associated with? What is the gene EXT1. Autosomal dominant with variable of mutation and penetrance. Affect the prehypertrophic inheritance pattern? chondrocytes of the physis What is the treatment While surgery for resection is for MHE? an indication if lesions are large enough to cause symptoms, many patients can be followed-up with observation alone. Most patients are asymptomatic and never seek medical attention at all Where are giant Metaphysis of long bones in middle age cell tumors typically (30–50) females found? How do they appear Eccentric lytic lesions on radiographs? Chapter 160 Malignant Bone Tumors Adam Driesman, Jose M. Ramirez, and Richard Terek

What patient demographic Young adults. Mostly occur in is most commonly affected the second decade of life during by osteosarcoma? adolescent growth spurt What skeletal sites Areas of rapid bone turnover. Distal are most common for femur, proximal tibia, proximal osteosarcoma? humerus (continued)

A. Driesman, MD (*) Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA Drs. Ramirez and Terek are at associated with Brown University, Providence, RI, USA e-mail: [email protected] J. M. Ramirez, MD Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA R. Terek, MD Warren Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

© Springer International Publishing AG, part of Springer Nature 2018 359 A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review, https://doi.org/10.1007/978-3-319-78387-1_160 360 A. Driesman et al.

(continued) How can osteosarcomas be Primary (85%) vs. secondary subcategorized Surface subtypes: Perosteal, periosteal, high grade surface Intramedullary subtypes: Conventional, telangiectatic, low- grade, small-cell What symptoms New-onset pain over several months, are associated with swelling, fever. Pain may disrupt osteosarcomas? sleep What is the most Tumor stage important prognostic Other poor prognostic factor in factor at time of diagnosis? response to chemotherapy What is typically seen Classically periosteal reaction on imaging for an (Codman’s triangle). Lesion with ill- osteosarcoma? defined borders, osteoblastic and/or osteolytic features What is the treatment for Limb salvage/wide osteosarcoma? resection + preoperative and postoperative multi-agent chemo What are survival rates for Survival rates surpass 70% osteosarcoma? What age range are 40–60 for primary lesions chondrosarcomas typically 25–45 for secondary: Arises from found in? preexisting benign cartilage lesions (i.e., multiple enchondromas and multiple hereditary exostosis In what locations are Pelvis, proximal femur, proximal chondrosarcomas typically humerus found? What genetic translocation t(11:22). Formation of fusion protein results in Ewing sarcoma? (EWS-FLI1) What population is Ewing Patients younger than the age of 10 sarcoma the most common nonhematologic primary malignancy of bone? Chapter 161 Myositis Stuart T. Schwartz

What is a heliotrope rash? A lilac colored periorbital rash seen in dermatomyositis What are “mechanic’s hands”? Cracked and fissured skin on the fingers of patients with dermatomyositis What antibodies are present in Anti-synthetase antibodies myositis patients associated with interstitial lung disease? What serious underlying Underlying malignancy condition needs to be looked for in patients diagnosed with polymyositis and dermatomyositis? (continued)

S. T. Schwartz, MD Alpert Medical School of Brown University, Providence, RI, USA e-mail: [email protected]

(continued) What blood test is typically CPK elevated in inflammatory myopathy? What myositis-specific antibody Anti-Mi-2 is seen with dermatomyositis skin rash? What are Gottron’s plaques? Erythematous to purple lesions, present over the IP and MCP joints in patients with dermatomyositis Index

A Acromioclavicular (AC) joint Abdominal viscera injuries, 233 allograft reconstruction, 30 Acetabular fractures posterosuperior joint capsule, complication, 218 30 hip extension and knee Rockwood classification, 29 flexion, 218 Zanca view and comparative iliac oblique, 217 images, 29 obturator oblique, 217 Acute carpal tunnel syndrome, spur sign, 218 66, 85, 104 types of, 217 Adhesive capsulitis Achilles tendon repair, 181 demographic affected people, Achilles tendon rupture, 181 21 first line of treatment, 196 endocrine disorders, 21 flexor hallucis longus, 195 joint capsule, 21 fluoroquinolones, 195 limited passive range of histology of, 196 motion in external risk factors, 195 rotation, 22 sural nerve, 195 pain of insidious onset, 21 Thompson test, 195 physical exam, 21 Achondroplasia treatment, 22 autosomal dominant, 285 Adult spinal deformity FGFR3, 285 abnormal positive sagittal FGR3 receptor, 289 balance, 239 foramen magnum stenosis, 286 abnormal sagittal balance, 240 genu varum, 285 lumbar lordosis measurement, kyphosis, 286 240 provisional calcification, 285 pelvic incidence, 239 spinal stenosis, 286 sagittal vertical axis, 239

American Spinal Injury operative fixation, 308 Association (ASIA), 228 Antibiotic, 6, 8, 11, 154, 195, 198, Angular variations 330, 332 foot-progression angle, 251 Anti-cyclic citrullinated peptide guided growth/osteotomies, antibodies, 335 252 Anti-double-stranded DNA internal and external rotation antibody (anti- of hip measurement, dsDNA), 353 251 Anti-histone antibody, 354 intoeing, 252 Anti-Mi-2 antibody, 362 rotational profile, 251 Anti-nuclear antigen (ANA), 353 thigh-foot angle, 251 Antiphospholipid antibodies, 354 tibiofemoral angle in young Antiphospholipid syndrome, 355 child, 252 Anti-Sm antibodies, 353 tibiofemoral angle, adult, 252 Anti-SSa (Rho) antibodies, 354 Ankle arthrodesis, 213 Anti-SSb (La) antibodies, 354 Ankle arthroplasty, 213 Anti-synthetase antibodies, 361 Ankle-brachial index (ABI), 11, Apert syndrome, 296 148, 173, 197 Arcade of Frohse, 72 Ankle sprain/fracture Arthritic foot ATFL ligament damage, 183 ankle arthrodesis vs. ankle Brostrom procedure/modified arthroplasty, 213 Brostrom procedure, 184 calcaneal fractures, 213 indications for surgery, 184 risk of joint fusion, 213 lateral ligaments, 183 subtalar joint, 213 medial clear space Arthritis measurement, 184 fibrocartilage, 291 MRI, 184 layers of articular cartilage, osteochondral fractures/ 291 defects, 183 radiographic signs of, 291 peroneal tendon pathology, 183 Type II collagen, 291 syndesmotic injury, 183, 184 Arthritis mutilans, 117 tibiofibular clear space Arthrocentesis, 4 measurement, 184 Arthrodesis, 4 Ankylosing spondylitis, 341, 342 Arthrogryposis, 314 Anterior cord injury, 229 autosomal recessive, 284 Anterior cruciate ligament clubfoot deformity, 283 (ACL), 147 lower extremities, position of, acute, 147 283 technical error, 148 spine deformity, 284 Anterior posterior compression upper extremities, position of, (APC), 215 283 Anterior talofibular ligament Arthroplasty, 4 (ATFL), 183 Arthroscopy, 4 Anterolateral bowing Articular (hyaline) cartilage bracing, 307 components, 333 Index 365

destruction, 12 musculocutaneous nerve, 37 zones, 333 popeye deformity, 38 Atlantoaxial instability, 319 posterior interosseous nerve Atraumatic, multidirectional, and lateral antebrachial bilateral, rehabilitation, cutaneous nerve, 38 and occasionally Bicondylar tibial plateau requiring an inferior fractures, 174 capsular shift Biofilm, 330 (AMBRI), 31 Biologic drugs, 342 Atypical bisphosphonate Bipartite patella, 160 subtrochanteric Bisphosphonates, 140, 265, 345 fracture, 345 osteonecrosis, 356 Avascular necrosis (AVN), 10, 81 PDB, 352 bisphosphonates, 140 Blood products, transfusion, 13 definition, 139 Blount’s disease, 297 direct causes of, 139 Bone biopsy, 350 indirect causes of, 139 Bone heals, types of, 8 MRI, 140 Bone pain, 351 operative interventions for Bone scan, 352 management, 140 Both bone fracture, 62 Steinberg Classification, 140 Boutonniere, 118 Avulsion fracture, 294 Boutonniere deformity, 96, 109, Axonotmesis, 111, 112 335 Boxer’s fractures complication, 92 B fourth and fifth metacarpals, Bado classification scheme, 63, 91 255 interossei muscles cause apex Bag of bones technique, 46 dorsal deformity, 91 Bamboo spine, 342 operative indications, 92 Bankart lesion, 31 surgical options for fixations, Baxter’s nerve, 209 92 Bean-shaped foot deformity, 310 true lateral radiographs, 91 Bennett fracture, 87 Brachial plexus birth palsy, 293, B-glucocerebrosidase, 289 294 Biceps tendon rupture Brachioradialis, 64 bicipital tuberosity of the Bracing, idiopathic scoliosis, 312 radius, 37 Brodsky classification, 200 coracoid process and superior Brostrom procedure/modified glenoid, 37 Brostrom procedure, eccentric contraction, 38 184 Hook test, 38 Brown-Sequard syndrome, 229 imaging test, 38 Bulbocavernosus reflex, 323 lacertus fibrosus, 38 Bunion deformity, see Hallux lacertus fibrosus originate and valgus insert, 37 Burst fracture, 233 366 Index

C types of dissociative Calcaneal fractures, 202, 213 instability, 103 Calcaneal navicular coalitions, X-ray findings, 103 310 Carpal tunnel syndrome Calcaneofibular ligament (CFL), diagnostic test, 68 183 digits, 67 Calcaneus fractures, 182 lunate, 67 facets, 187 median nerve, 67 flexor hallucis longus, 187 night splints, 68 Gissane angle and Bohler’s nonsurgical treatments, 68 angle, 188 physical exam tests, 68 Harris view, 188 risk factors, 67 lateral wall blow out with symptoms, 67 varus deformity, 188 transverse carpal ligament, 68 lumbar spine, 188 Carpometacarpal (CMC) joint, mechanism of, 187 97 posterior facet, 188 Cartilaginous coalitions, 310 Sanders classification, 188 Cauda equine syndrome, 12 shortening of the calcaneus, Cavovarus foot, 310 188 Cavo-varus foot deformity, 277 talus and cuboid bones, 187 Cavus foot, 278 Calcific tendinitis Cefazolin, 8 definition, 23 Central pain sensitization, 339 first-line treatment, 24 Central slip, 10 nonoperative management, Central slip injury, 109 24 Cerebral palsy, 314 phases, 23 brain insult, 271 risk factors, 23 GMFCS, 271 subacromial impingement hip subluxation, 272 tests, 24 scoliosis curve appearance, supraspinatus, 23 272 treatment, 24 spine problem, 272 Calcitriol, 350 static encephalopathy, 271 Calcium, 23, 24, 196, 338, 347, 349, surgical categories, 272 350 treatment, 272 Calcium pyrophosphate Cerebral palsy (CP), risk factors, deposition disease, 338 272 Campomelic dysplasia Cervical facet dislocation, 12 autosomal dominant, 288 Cervical spine fractures Sox 9, 288 closed reduction with Caput ulna, 118 sequential traction, 232 Carpal instability odontoid fracture, 231 classifications, 103 radiographic parameters, 231 perilunate injuries, reverse hamburger sign, 232 classification of, 103 spinal cord injury, 231 surgical option, 104 TAL, 231 Index 367

Cervical spine injuries, 323, 324 Chronic fatigue Cervical stenosis, 225 syndrome, 339 Chalk-stick fracture, 351 Chronic flexor tendon injuries, Chaput fragment, 193 107 Charcot arthropathy Chronic kidney disease-mineral Brodsky classification, 200 and bone disorder definition, 199 (CKD-MBD) diabetes, 199 components, 349 erythema, 200 feature, 350 ESR and WBC, 200 pathophysiology, 350 first line treatment, 200 stages, 350 Semmes-Weinstein Chronic pain syndrome, 339 monofilament testing, Chronic plantar fasciitis, 210 200 Cierny and Mader classification, symptoms of, 199 330 temporal stages for Clamshell bracing, 307 progression, 200 Clavicle fractures Charcot foot, 197 anterior versus posterior Charcot-Marie-Tooth (CMT) displacement, 27 disease, 205 hardware removal, 28 autosomal dominant, 289 intramembranous ossification, cavo-varus foot deformity, 277 27 cavus foot, 278 lateral third clavicle fractures, Coleman block test, 278 28 diagnostic tests, 278 ligaments attachment, 28 equinus, 278 middle third clavicle fracture, first foot abnormality, 278 28 hereditary motor-sensory Cleidocranial dysplasia, 293 neuropathy, 277 clavicle, 288 muscle imbalances, 277 RUNX 2 gene, 288 Chevron osteotomy, 180 Clinodactyly, 296 Child abuse Closed reduction and distal humerus physeal percutaneous pinning separation, 267 (CRPP), 3 metaphyseal corner fractures, Clubfoot, 309, 310 267 Clubfoot deformity, 283 skin lesion, 267 Cobb angle, 311 unreported physical abuse, Cold complex regional pain 267 syndrome, 121 Chondrocalcinosis, 338 Cold ischemia, 115 Chondroitin sulfate, 334 Coleman block test, 310 Chondromalacia of Collar button abscess, 124 patellofemoral joint, Colles fracture, 65 169 Compartment syndrome, 154, 174 Chondrosarcomas, 360 diagnostic test, 12 Chordoma, 242, 243 physical exam findings, 12 368 Index

Compensatory lumbar elbow dislocation, 51 hyperlordosis, 317 intra-articular structure, 51 Complete articular bicolumn medial ulnar collateral fractures, 45 ligament insertion, 51 Complete transverse patella Regan and Morrey fractures, 152 classification, 51 Complex and simple syndactyly, terrible triad injury, 51 296 Corticosteroids, 354 Complex regional pain syndrome Coxa vara, 265 (CRPS), 356 Cozen’s fracture, 300 chronic form of, 121 Crankshaft phenomenon, 312 diagnosis of, 121 C-reactive protein (CRP), 343 symptoms of, 121 Crescent sign, 356 treatment options, 122 Cruciate retaining implant, 168 vitamin C, 122 Crystal-induced arthropathy Composite graft technique, 99 gout crystals, 337 Computed tomography (CT), 6 medical treatment, 337 Congenital coxa vara pseudogout, 338 femoral neck shaft angle, 261 surgical emergency, 337 Hilgenreiner epiphyseal WBC, 337 angle, 261 Cubital tunnel syndrome Congenital foot disorder, 309 (CuTS), 18 Congenital hip dislocation (CHD) common hand functions, 70 Barlow exam maneuver, 259 compression distal to medial normal alpha angle, 259 epicondyle, 69 ortolani exam maneuver, 259 compression of ulnar nerve, risk factors, 259 site of, 69 treatment of, 259 compression proximal to Congenital pseudarthrosis of medial epicondyle, 69 tibia (CPT) diagnosis, 70 anterolateral bowing, 307, 308 Froment’s sign, 70 below-knee amputation, 308 nonoperative options, 70 neurofibromatosis type 1, 307 provocative tests, 70 Congenital scoliosis superficial nerve, 70 inheritance pattern, 315 surgical options, 70 in normal fetal development, symptoms of, 69 315 Cubitus varus deformity, 294 risk of progression, 316 types, 316 VACTERL association, 315 D Congenital vertical talus (CVT) Damage control orthopedics, 14, characteristics, 309 146 diagnostic test, 309 Dancer’s fracture, 192 neuromuscular disorder, 309 Dashboard injury, 134, 148 Contralateral hemivertebrae, 316 De Quervain’s tenosynovitis, 17 Coranoid fracture abductor pollicis longus, 75 anterior capsule of elbow, 51 extensor pollicis brevis, 75 Index 369

Finkelstein test, 76 DIPJs, 119 first dorsal compartment of Direct end-to-end nerve repair, the wrist, 75 112 location of pain, 75 Disc extrusion, 222 nonoperative treatment, 76 Disc protrusion, 222 superficial branch of the Disc sequestration, 222 radial nerve, 76 Disc space narrowing, 317 surgical treatment, 76 Discitis, 245 Deafness, 352 Disease-modifying Decompression sickness, 355 antirheumatic drugs Degenerative arthritis of hand (DMARDs), 118, 342 and wrist Disk herniation, 236 DIPJs, 119 Dislocation reduction, 10 DRUJ, 120 Distal femoral fractures PIPJs, 119 age distribution of, 157 SLAC wrist, 119, 120 angiography, indication for, 158 SNAC, stages of, 119 classification, 157 thumb CMC OA, 120 complications after treatment, thumb MCP, 119 158 Degenerative joint disease of CT scan, indication for, 158 elbow definition, 157 articular cartilage, 55 imaging study, 158 articulations, 55 implants, 158 elbow arthritis, 55 mechanism of injury, 157 total elbow arthroplasty, 56 nonoperative treatment, 158 Delayed union, 8, 40 popliteal artery, 158 Dermatomyositis, 361, 362 surgery, 158 Diabetic foot treatment for, 158 ABI, 197 typical displacement of, 158 anaerobic antibiotic, 198 Distal femoral physis, , indication Charcot foot, 197 for, 303 infectious organisms, 198 Distal humerus fractures primary treatment, 198 bag of bones technique, 46 Semmes-Weinstein 5.07 classification, 45 monofilament, 197 complete articular bicolumn ulcers fractures, 45 classification system, 198 complications, 46 etiology of, 197 computed tomography Diabetics, trigger finger, 79 scanning, 45 Diastrophic dysplasia double arch sign, 46 autosomal recessive, 287 nonoperative hitchhiker thumb and management, 46 cauliflower ears, 287 operative options, 46 sulfate transport protein, 287 partial articular single column Diffuse idiopathic skeletal fractures, 45 hyperostosis surgical approaches to the (DISH), 232 elbow, 46 370 Index

Distal humerus physeal ulnar nerve, 56 separation, 267 Elbow dislocations Distal radial ulnar joint (DRUJ), complications, 54 49, 118, 120 direction of, 53 Distal radius fracture, 122, 253, 346 dynamic stabilizers, 53 acute carpal tunnel posterolateral, 53 syndrome, 66 primary static stabilizers, 53 colles fracture, 65 surgical indications, 54 Dexa scan, 65 terrible triad, 54 distal radial-ulnar joint, 65 typical position of splinting, smiths fracture, 65 54 triangular fibrocartilage Elson’s test, 110 complex, 66 End plate changes, 317 volar tilt, 65 Enteropathic arthritis, 341 Distal segment, 4, 7, 146 Enthesitis, 342 Distal ulna fracture, 66 Epidural hematoma, 234 Dorsal dislocation, 10, 309 Epineural repair, 112 Dorsal distal interphalangeal Epiphyseal growth plates, 347 (DIP) joint Epiphysiodesis, 303, 306 dislocations, 96, 119 Equinovarus foot Dorsiflexion-eversion test, 202 deformity, 281 Double arch sign, 46 Erythema, 200 Down syndrome, 257, 289 Erythrocyte sedimentation rate Dupuytren’s disease (ESR), 343 collagenase enzyme, 77 Essex-Lopresti and sanders complication, surgical classification systems, excision, 78 182 myofibroblasts, 77 Essex-Lopresti injury, 49 palm to table test, 77 Essex-Lopresti lesion, 64 small and ring fingers, 77 Ewing sarcoma, 360 spiral cord, 78 Extensor carpi radialis brevis surgical treatment, 78 (ECRB), 41 tissue, cause of, 77 Extensor lag, 152, 161 Durkan’s carpal compression Extensor mechanism, 159 test, 18 Extensor mechanism injuries Dwarfism, 285 complete transverse patella fractures, 152 components, 151 E Krackow, 152 Eccentric lytic lesions, 358 physical exam, 152 Eichhoff maneuver, 76 Extensor tendon injuries Elbow arthritis classic nonoperative cause of, 55 treatment, 110 indication for total elbow Elson’s test, 110 arthroplasty, 56 EPL rupture, treatment for, 110 terminal extension, 56 fight bite injury, 109 Index 371

nondisplaced distal radius symptoms, 340 fractures, 110 treatment, 340 operative options, 110 younger female, 339 zone I injury, 109 Fibrous coalitions, 310 zone III injury, 109 Fight bite injury, 109 Zone VI, 109 Finger metacarpal fractures External fixator, 4 indications for surgical Extensor pollicis longus (EPL) management, 97 rupture, 110 nonoperative management, 97 External snapping hip shaft angulation anatomic structures, 127 acceptability, 97 surgical treatment for, 127 Finkelstein test, 76 trendelenburg gait, 127 First-generation cephalosporin, 8 Extracorporeal shockwave First metacarpal base fracture, 87 therapy, 24 Fishtail deformity, 294 Extraskeletal calcification, 349 Fixed musculotendinous Extremity shortening, 10 contracture, 272 Flat foot flexible deformity (Stage II) F vs. rigid deformity Fanconi’s anemia, 296 (Stage III), 207 Fasciectomy, 78 forefoot abduction, 208 Fatigue fracture, 175 peroneus brevis, 207 Felon, 123 subfibular impingment, 208 Felty’s syndrome, 336 tarsal coalition, 207 Femoral head, 10, 135, 141, 165, Fleck sign, 205 218, 239, 257, 355 Flexible hindfoot, 310 Femoral head fractures, 134, 269 Flexor digitorum profundus Femoral neck fractures (FDP), 106 orthopedic complications, 129 Flexor digitorum superficialis Femoral shaft fractures (FDS), 106 external fixation, 146 Flexor hallucis longus tendons, intramedullary nailing, 146 202 operative extremity, 145 Flexor pulley system, 106 Femur fracture, blood loss, 13 Flexor tendon Fibroblast growth factor 3 diffusion, 107 (FGFR3), 285 lacerations, 107 Fibroblast growth factor 23 zones, 105 (FGF23), 350 Flexor tenosynovitis, 124 Fibromyalgia Fluoroquinolones, 195 cardinal symptoms, 339 Foot progression angle, 301 diagnosis, 340 Foramen magnum stenosis, 286 non-pharmacologic Forefoot abduction, 208 interventions, 340 Forefoot plantar flexion, 310 pathophysiology, 339 Four-corner arthrodesis (FCA), 120 primary sleep disorders, 340 Fracture, 6, 7 372 Index

Fragility fractures, 346 shoulder internal rotators Friedreich’s Ataxia, 314 overpower external Froment’s sign, 70 rotators, 32 Full range of motion (FROM), 3 TUBS, 31 Glomerular filtration rate (GFR), 350 G Golfer’s elbow Galeazzi fracture cause of, 42 brachioradialis, 64 classic exam findings, 42 DRUJ injury, 64 effective treatment, 42 Essex-Lopresti lesion, 64 neurologic disorder, 42 pronator quadratus, 64 Gottron’s plaques, 362 treatment, 64 Gout crystals, 337 Gamekeeper’s thumb, see Skier’s Gower’s sign, 281 thumb Graded motor therapy, 122 Garrod’s pads, 78 Granulomatous infections, 245 Gas gangrene, 124, 332 Greater trochanter, 127 Gaucher’s disease, 289, 355 Grisel’s disease, 319 Genu valgum, 252 Gross Motor Function age, 299 Classification System Cozen’s fracture, 300 (GMFCS), 271 lateral compartment, 300 Grouped fascicular repair, 112 miserable malalignment, 299 Gustilo-Anderson classification, normal amount, 299 11, 154 proximal tibia lateral opening Guyon’s canal wedge osteotomy, 300 boundaries of, 72 treatment of choice, 300 ulnar nerve, 72 Genu varum, 252, 285 zones of, 72 Langenskiöld classification, Gymnast’s wrist, 295 298 medial compartment, 298 medical conditions, 297 H risk factors, 297 Hallux valgus Giant cell arteritis (GCA), 344 adult and juvenile, 179 symptoms, 344 Chevron osteotomy, 180 treatment, 344 first-line treatment, 179 Giant cell tumors, 358 HVA, 180 Glenohumeral arthritis, 20 IMA, 180 Glenohumeral joint Lapidus procedure, AMBRI, 31 indications for, 180 Bankart lesion, 31 Ludloff osteotomy, 180 HAGL lesion, 32 Mitchell osteotomy, 180 Hill Sachs lesion, 31 Scarf osteotomy, 180 lightbulb sign, 32 sesamoids, 180 posterior dislocations, 32 symptoms, 179 posterior glenoid, 32 Hallux valgus angle (HVA), 180 Index 373

Hamate fractures, carpal tunnel conservative treatment for, view, 83 137 Hand infections definition, 137 collar button abscess, 124 lateral femoral cutaneous deep spaces of the hand, 123 nerve, 138 Eikenella corrodens (human physical exam for patient, 137 bite), 123 posterior, 138 gas gangrene, 124 radiographic findings, 137 Kanavel’s signs, 124 Southern/Moore, 138 necrotizing fasciitis, 124 Hip osteonecrosis, see Avascular Parona’s space, 123 necrosis Pasteurella multocida (cat Hoffa fracture, 158 bite), 123 Holt-Oram syndrome, 296 Hawkins classification, 185 Hook test, 38 Hawkins sign, 186 Hornblower’s sign, 20 Heel Human leukocyte antigen B27 anatomical tendons/nerves, (HLA-B27), 342 181 Humeral avulsion of the inferior anterior to posterior, 181 glenohumeral ligament Heel pain (HAGL), 32 Achilles tendon ruptures, 181 Humeral shaft fractures, 14 intra-articular calcaneus complications, 40 fractures, 182 indications for operative MRI, 182 management, 40 normal angle of Gissane, 182 mechanism of, 40 normal Bohler angle neurovascular injuries, 40 measurement, 182 nonoperative treatment, 40 tarsal fracture, 181 operative treatments, 40 Heliotrope rash, 361 primary deforming forces, 39 Heterotopic ossification (HO), reduction criteria for 218 nonoperative Hill Sachs lesion, 31 management, 39 Hindfoot varus, 310 Hydroxychloroquine, 118, 354 Hip dislocations Hypothenar tenderness, 84 anterior, 134 characteristics, 133 classification, 133 I complications, 135 Idiopathic scoliosis CT scan, 134 bracing, 312 incidence of, 133 indications, 311 physical exam findings, 10 posterior fusion, 312 posterior, 133, 134 right thoracic curve, 311 treatment, 134 treatment modalities, 312 Hip fracture, 346 Iliotibial (IT) band syndrome Hip osteoarthritis anatomic structures, 171 anterior, 138 limb alignment issue, 171 374 Index

surgical intervention, 171 K treatment method, 171 Kanavel’s signs, 124 Iliotibial band snapping, 127 Kienbock’s disease Inflammatory erosive synovial classic radiographic risk tissue, 335 factor, 74 Inflammatory joint arthritis, 342 natural history of, 74 Injury Severity Score (ISS), 14 pathophysiology, 73 Insufficiency fracture, 175 stages of, 73 Intermetatarsal angle (IMA), 180 surgical options, 74 Intermetatarsal ligament, 211 typical history of a patient, 74 Internal tibial torsion, 301 Klein’s line, 258 Intervertebral disc Klippel-Feil syndrome, 319 central and paracentral disc Klotho, 350 herniations effect, 222 Knee dislocation, 10 collagen, 221 Knee injury components of, 221 ACL disc extrusion, 222 anterior tibial translation, disc protrusion, 222 147 disc sequestration, 222 technical error, 148 foraminal and extra-foraminal acute ACL rupture, 147 disc herniations effect, cruciate ligaments, 147 222 multi-ligamentous, 148 function of, 221 unhappy triad, 147 Intoeing, 252, 301 Krackow, 152 Intra-articular calcaneus Kyphosis, 286 fractures, 182 Intramedullary nailing, 146 Intramembranous ossification, 27, L 293 Langenskiöld classification, 298 Intraoperative periprosthetic Lapidus procedure, 180 femur fractures, 142 Lateral compression (LC), 215 Involucrum, 330 Lateral epicondylitis, see Tennis Ipsilateral femoral neck fracture, elbow 145 Lateral femoral epicondyle, 171 Iselin’s disease, 263 Lateral meniscus, 147, 174 Lateral subtalar dislocation, block reduction, 10 J Lauge-Hansen classification, 184 Jahss technique, 98 LC-III injury, 216 Joint aspiration, 12 Leach of Henry, 72 Joint dislocation, 9 Leg length discrepancy, 303 Joint infection, 327 Legg-Calve-Perthes disease Jones fracture, 192 crescent sign, 269 Jupiter classification system, 45 fragmentation, 269 Juvenile idiopathic arthritis, 341 MED, 269 Index 375

Waldenström stages of, 269 lunotriquetral, disruption of, Letournal classification, 217 86 L5-S1 isthmic spondylolisthesis, Mayfield classification, 85 322 scapholunate ligament Ligament vs. tendon, 4 disruption, 86 Ligament of Struthers, 72 Lupus rash, 354 Lightbulb sign, 32 Limb length discrepancy (LLD) accurate assessment, 305, 306 M classification, 305 Madelung’s deformity, 295 treatment, 306 Magnetic resonance imaging Lisfranc fracture injury (MRI), 6, 12, 38, 73, 82, articulations of Lisfrac joint 127, 131, 140, 161, 164, complex, 189 175, 178, 182, 184, 203, indication for ORIF, 189 206, 247, 311, 316, 320, Lisfranc ligament, 189, 190 356 mechanism of, 189 Mallet finger deformity, 109 plantar ecchymosis sign, 189 Malunion, 8, 26, 40, 46, 62, 130, Lisfranc/Lisfranc equivalent 131, 158, 186, 294 injuries, 191 Manske’s pulley, 80 Little Leaguer’s shoulder, 294 Mason classification, 49 Locking plates, 346 Mayfield classification, 85, 103 Long bone fracture, 14 Mean arterial pressure (MAP), Longitudinal growth, 303 229 Loose bodies, 60 Mechanic’s hands, 361 Low back pain Mechanical lateral distal femoral cause of, 235 angle (mLDFA), 300 differential diagnosis, 236 Medial collateral ligament imaging for, 236 (MCL), 59, 147 risk factors, 235 Medial epicondylitis, see Golfer’s Waddell signs, 236 elbow Lower extremity trauma, 14 Medial meniscus injury, 147 Lubrication forms, 334 Medial parapatellar approach, Ludloff osteotomy, 180 166 Lumbar disc herniation, red flag Medial patellafemoral ligament symptoms, 12 (MPFL), 163 Lumbar lordosis, 239, 240 Medial proximal tibial angle Lumbar spine conditions, see (MPTA), 300 Low back pain Meniscus tears Lunate dislocation lateral, 150 arcs, 85 medial, 150 capitolunate articulation, vertical mattress sutures, 149 disruption of, 86 zones of, 149 emergency condition, 85 Metacarpal fractures, surgical lateral wrist radiograph, 86 options, 98 376 Index

Metacarpal neck fractures, 98 operative management, 178 Metacarpophalangeal (MCP) physical exam, 178 joint, 98, 118 plantar surgical approach, Metaphyseal corner fractures, disadvantages to, 211 267 radiographic method, 178 Metastatic disease, 241 Multiple epiphyseal dysplasia Metastatic renal cell carcinoma, (MED), 269 242 Multiple hereditary exostosis Metatarsal (MT) fracture (MHE), 358 conservative treatment, 191 Muscular dystrophy (MD), 314 dancer’s fracture, 192 Becker’s MD, 281 Jones fracture, 192 Duchenne’s MD, 281 Lisfranc/Lisfranc equivalent dystrophin protein, 281 injuries, 191 equinovarus foot deformity, location of, 191 281 metabolic bone disease/ Gower’s sign, 281 amenorrhea, 191 x-linked recessive, 281 primary nonoperative Musculo-tendinous structure, 207 treatment?, 191 Myelodysplasia, see Spina bifida Metatarsalgia Myositis, 362 causes of, 177 definition, 177 Morton’s neuroma, 177 N location, 177 Necrotizing fasciitis, 124 management, 178 clinical physical exam signs, radiographic method, 178 332 Metatarsus adductus, 310 immunosuppression, 331 Mid-shaft femur fracture, 146 mortality rate, 332 Milch classification system, 45 non-group A streptococci, 331 Mirror therapy, 122 origin, 332 Miserable malalignment polymicrobial, 331 syndrome, 163 rapid progression, 331 Mitchell osteotomy, 180 treatment, 332 Moberg flap, 100 Needle barbotage, 24 Monostatic disease, 352 Neer classification, 25 Monteggia fractures, 255 Nerve conduits, 112 classification system, 63 Nerve injury outstretched arm in axonotmetic nerve injury, 112 hyperpronation, 64 categories of, 111 PIN injury, 64 connective tissue layers of Morton neuroma nerve, 111 definition, 177 epineural repair, 112 intermetatarsal ligament, 211 grouped fascicular repair, 112 location for, 177, 211 growth of peripheral nonoperative therapies, 211 nerve, 112 Index 377

neuropraxia and Oral glucocorticoids, 344 axonotmesis, 112 Orthopaedic terminology, 3 rule of 18, 113 Orthopedic emergency, 11, 328 water immersion testing, 112 Ortolani exam maneuver, 259 Neurofibromatosis, 314 Osgood-Schlatter’s disease, 263 type 1, 307 Os odontoideum, 320 Neurogenic claudication, 225 Osseous coalitions, 310 Neurogenic shock, 228, 323 Osteoarthritis Neurologic level of injury, 323 chondroitin sulfate, 334 Neuromuscular scoliosis, 313, 314 deep and superficial Neuropraxia, 111 laceration, 334 Neurotmesis, 111 keratin sulfate, 334 Neurovascular injuries, 40 lubrication forms, 334 Nightstick fracture, 62 normal aging, 333 Non weight bearing (NWB), 3 upper extremity Nondisplaced distal radius Bouchard’s nodes, 57 fractures, 110 DIP joints, 57 Non-union, 8 Heberden nodes, 57 Notta’s node/nodule, 80 radiographic findings, 57 Nutritional markers, 314 symptoms of, 57 thumb CMC arthritis, 58 Osteoblastoma, 242, 243 O Osteochondral fractures/defects, Odontoid fractures, 231, 320, 324 183 Olecranon apophyseal avulsion Osteochondroma, 242, 358 fracture, 265 Osteochondritis dissecans Olecranon bursitis (OCD) blood tests, 43 common location, 263 gram stain and culture, 43 Iselin’s disease, 263 non-painful, 43 Osgood-Schlatter’s disease, sterile aspiration, 43 263 Olecranon fracture Sinding-Larsen Johansson simple transverse olecranon syndrome, 263 fracture, 47 Osteogenesis imperfecta (OI) treatment, 48 basilar invagination, 265 triceps tendon, 47 bisphosphonate therapy, 265 trochlea of the distal humerus, lower extremity deformity, 47 265 Open fractures, 4, 8, 11 type 1 collagen, 265 Open reduction and internal upper extremity fracture, 265 fixation (ORIF), 3, 50, Osteoid osteoma, 243, 357, 358 62, 98 Osteomalacia bicondylar tibial plateau causes, 347 fractures, 174 clinical presentation, 348 Lisfranc fracture injury, 189 symptoms, 348 378 Index

Osteomyelitis Palmar aponeurosis pulley, 80 classification, 330 Panner’s disease, 294 diagnosis, 330 Parathyroid hormone, 348 inflammatory markers, 330 Parona’s space, 123 sickle cell patients, 329 Paronychia, 123 Staph aureus, 329 Pars interarticularis, 223 transmission, 329 Passively correctable deformity, Osteonecrosis, 129 118 alcohol, 355 Patella diagnosis, 356 blood supply, 159 differential diagnosis, 356 extensor mechanism, 159 of femoral head, 135 facets, 159 glucocorticoids, 355 Patellar dislocation pathognomonic sign, 356 bony injury, 164 site, 355 risk factors, 163 surgical treatment, 356 sunrise view radiograph, 164 trauma, 355 TT-TG distance, 164 Osteoporosis, 129 Patellar fracture bisphosphonates, 345 indications for nonoperative locking plates, 346 treatment, 160 T-score, 345 mechanism of, 160 Osteosarcomas physical exam, 160 periosteal reaction, 360 surgical indications, 160 primary vs. secondary, 360 surgical options of fixation, prognostic factor, 360 160 rapid bone turnover, 359 types of, 160 survival rates, 360 X-ray, 160 symptoms, 360 Patellar tendon, 151, 152 treatment, 360 rupture, 161 young adults, 359 Patellofemoral pain syndrome Osteotomy, 4, 46, 58, 74, 140, 261, classification of 300, 356 chondromalacia, 169 Outtoeing, 251 first-line management, 169 pathology, 169 Pathognomonic sign, 356 P Pathological fracture, 8, 40 Paget’s disease of the bone Pediatric cervical spine disorders (PDB) anterior translation, 320 clinical presentation, 351 basilar invagination, 320 imaging modality, 352 CT myelogram, 320 monostatic disease, 352 Os odontoideum, 320 neurologic complication, 352 pseudosubluxaton, 320 symptom, 351 rotary atlantoaxial treatment days, 352 subluxation, 319 treatment of choice, 352 Pediatric fractures typical atraumatic fracture, 351 clinical finding, 254 Index 379

Harris growth arrest line, 254 Phalangeal fractures Salter-Harris I fractures, 254 apex dorsal, 93 Pediatric trigger thumb, 296 apex volar, 93 Pelvic incidence, 239 complication, 94 Pelvic instability, 14 distal phalanx, 93 Pelvic ring injuries, 216 operative indications, 94 APC-II and APC-III injury, Phosphate, 338, 347, 350 216 Pilon fractures greater trochanters, 216 chaput fragment, 193 inlet X-ray view, 215 CT scan, 193 outlet X-ray view, 215 definition, 193 pelvic binder, 216 initial treatment, 193 posterior sacroiliac risk factor, 194 ligamentous complex, Volkmann fragment of the 215 distal tibia, 194 vertical shear, 216 Wagstaff fragment, 194 Young-Burgess classification, Plain X-rays, 5 215 Plantar ecchymosis sign, 189 Pencil-in-cup deformity, 117 Plantar fasciitis Perilunate dislocation Baxter’s nerve, 209 arcs, 85 cast/boot immobilization, 210 carpal bone fracture, 85 chronic, 210 capitolunate articulation, first line of treatment, 209 disruption of, 86 medial tuberosity of emergency condition, 85 calcaneus, 209 lateral wrist radiograph, 86 risk factors, 209 lunotriquetral, disruption of, 86 symptoms, 209 Mayfield classification, 85 Polio, 314 scapholunate ligament Polymicrobial infections, 331 disruption, 86 Polymyalgia rheumatic (PMR) Peripheral neuropathy, 197 age of onset, 343 Periprosthetic femur fracture, 143 laboratory findings, 343 Periprosthetic fractures, 167 steroids, 344 Peroneal branch of sciatic nerve, symptoms, 343 142 treatment, 344 Peroneal tendons Polymyositis, 361 Charcot-Marie Tooth, 205 Ponseti casting method, 310 fleck sign, 205 Popeye deformity, 38 injury, imaging study, 206 Popliteal artery injury, 148 mechanism of peroneal injury, Post-axial and pre-axial 206 polydactyly, 295 pain, posterior lateral ankle, 205 Posterior cruciate ligament pathology, 183 (PCL) tear, 148 peroneus brevis, 206 Posterior interosseous nerve provocative test, 205 (PIN), 72 SPR, 205 injury, 64 380 Index

Posterior sacroiliac ligamentous surgical neck, 25 complex, 215, 216 surgical options, 26 posterior stabilizing implant, 168 X-ray views, 25 Posterior talofibular ligament Proximal humerus fracture, 346 (PFL), 183 Proximal interphalangeal (PIP) Posterior tibial tendon, 10 joint, 78, 119 Post-operative periprosthetic Proximal interphalangeal (PIP) femur fractures, 142 joint dislocation, 95, 96 Postoperative wound infections, dorsal, 95 245 Swan neck deformity, 95 Posttraumatic arthritis of the treatment, 96 elbow volar plate and at least imaging modality, 59 one collateral ligament, location for osteophytes, 60 95 MCL, 59 rotary, 96 nerve complication of volar ulnohumeral Boutonniere deformity, 96 arthroplasty, 60 central slip and at least ROM, 59 one collateral ligament, test, 59 95 total elbow arthroplasty, 60 treatment, 96 Pre-axial polydactyly, 295 Proximal radioulnar joints, 55 Primary sleep disorders, 340 Proximal row carpectomy (PRC), Progressive kyphosis, 234 74, 120 Pronator quadratus, 64 Proximal tibia lateral opening Pronator syndrome wedge osteotomy, 300 diagnosis, 72 Proximal tibia physis, 303, 305 median nerve, 71 Pseudogout, 338 sites of compression, 72 Psoriatic arthritis, 341 Proximal femur fracture pencil-in-cup deformity, 117 characteristics, 131 vs. RA, 118 clinical finding, 129 imaging study, 130 mechanism of injury, 129 Q MRI scan, 131 Quadriceps tendon rupture, 151 position of malunions, 131 complications, 162 predisposing factor, 129 radiographic finding, 162 surgical treatment, 130 risk factors for, 162 treatment for, 130 treatment for acute or Proximal humeral fractures chronic, 162 blood supply to humeral head, 25 complications, 26 R nonoperative management, Rachitic rosary, 348 26 Radial club hand, 296 parts, 25 Radial head dislocations Index 381

asymptomatic congenital, Renal osteodystrophy, 350 treatment for, 255 Replantation Bado classification scheme, cold ischemia, 115 255 indications, 115 elbow extension/forearm mechanism of injury, 115 supination, 256 multiple digit, 116 Monteggia fracture, 255 warm ischemia, 115 radiocapitellar line, 256 Resuscitation, 13 Radial head fractures Rett syndrome, 314 aspirate elbow hematoma and Reverse hamburger inject lidocaine, 50 sign, 232 classification, 49 Reverse total shoulder early ROM to avoid elbow arthroplasty, 20, 33 stiffness, 50 Revision finger amputation elbow fully extended and absorbable monofilament, 99 forearm pronated arm, cold intolerance, 99 49 complication, 100 Essex-Lopresti injury, 49 composite graft technique, 99 fragments, 50 mechanism of a lumbrical PIN, 50 plus finger, 100 safe zones for ORIF, 50 Moberg flap, 100 surgical treatment options, 50 transverse or dorsal oblique, vs. fragment excision, 50 99 Radial shaft fracture Rheumatoid arthritis (RA), 34, complications, 62 55, 56 Volar approach of Henry and C1–C2 subluxation, 335 dorsal (Thompson) diagnostic serologies, 335 approach, 62 DIP joints, 335 Radial tunnel syndrome Felty’s syndrome, 336 PIN, 72 fixed deformity, 118 sites of compression, 72 inflammatory erosive synovial Radiocapitellar arthritis, 60 tissue, 335 Radiocapitellar joints, 55 MCP joints, 118 Radiographic densities, 6 passively correctable Radiology, 5–6 deformity, 118 Radius fracture rheumatoid nodules, 336 ipsilateral elbow and wrist swan neck and boutonniere radiographs, 61 deformities, 335 restoration of the radial bow, treatment options, 118 62 vs. psoriatic arthritis, 118 Sugartong, 61 Rheumatoid factor, 335 Reactive arthritis, 341 Rheumatoid nodules, 336 Reflex sympathetic Rickets, 347, 348 dystrophy, 356 Rigid flat foot, 310 Regan and Morrey Rockwood classification, 29 classification, 51 Rolando fracture, 87 382 Index

Rotary atlantoaxial Septic arthritis subluxation, 319 classic presentation, 327 Rotator cuff deficiency, 33 classic workup, 328 Rotator cuff tendons definition, 327 Hornblower’s sign, 20 definitive treatment, 328 subscapularis insertion, 19 IV drug users, 328 symptom, 20 mechanisms, 327 teres minor, 19 Staph aureus, 327 treatment for patients, 20 symptoms, 328 Septic joint consequence, 12 S joint aspiration, 12 Sacroiliitis, 342 Sequestrum, 330 Salter-Harris type 1 injury, 254, Seronegative 324 spondyloarthropathies Sanders classification, 182, 188 definition, 341 Scaphoid fracture genetic marker, 342 cause of, 82 manifestations, 342 CT scan or MRI, 82 radiographic spine features, implants, 82 342 lunate bone, 81 treatment, 342 nonunion of a scaphoid, 82 Serum marker value, 13 physical exam, 82 Shopping cart sign, 226 proximal pole scaphoid Shoulder dislocation, 9 fracture, 81 Sickle cell disease, 355 SNAC wrist, 81 Silicon metacarpophalangeal waist fracture, 81 (MCP) joint Scaphoid nonunion advanced replacement, 34 collapse (SNAC) Sinding-Larsen Johansson wrist), 81, 119 syndrome, 263 Scapho-lunate advanced collapse Skier’s thumb (SLAC) wrist, 119, 120 adductor pollicus aponeurosis, Scapholunate ligament tear, 103 89 Scapulothoracic dissociation, 14 definition, 89 Scarf osteotomy, 180 imaging, 90 Schatzker classification, 173 mechanism of injury, 90 Scheuermann’s kyphosis, 317 operative indications, 90 Schmorl nodes, 317 Stener lesion, 89 Sciatic nerve, 138 Skin lesion, 267 Scoliosis, 272, 317 Slipped capital femoral epiphysis Seat belt injuries, 233 (SCFE) Secondary hyperparathyroidism, classification, 257 350 Klein’s line, 258 Semmes-Weinstein obligate external rotation monofilament sign, 258 testing, 200 radiographic view, 258 Index 383

risk factors, 257 Staphylococcus aureus, 246 treatment, 258 types of, 245 unstable, 257 vertebral osteomyelitis, 247 Smith-Petersen approach, 138 Spine tumors Smiths fracture, 65 adjuvant treatment, 242 Soft tissue injury, 154 benign, 242 Spina bifida, 314 chordoma, 243 alpha-fetoprotein test, 275 conditions, 241 folate supplementation, 275 histological features, 243 L4, 275 metastatic disease, 241 latex allergy, 275 metastatic spine rapid scoliosis curve lesions, 242 progression, 276 osteoid osteoma/ type II Arnold-Chiari osteoblastoma, 243 malformation, 275 primary malignant, X-rays, 276 242, 243 Spinal abnormalities, 316, 348 Takuhashi scoring Spinal cord injury (SCI) system, 242 anterior cord injury, 229 Spondylolisthesis, 321, 322 ASIA grades, 228 Hamstring tightness, 224 Brown-Sequard syndrome, isthmic, 224 229 types of, 224 cervical central stenosis/ Spondylolysis, 317, 321 spondylosis, 229 clinical presentation, 223 cervical spine fractures, 231 Hamstring tightness, 224 level of, 228 incidence of, 224 MAP, 229 X-ray findings, 223 neurogenic shock, 228 Spondyloptosis, 321 physical exam, 228 Spontaneous spinothalamic tract, 227 osteonecrosis of knee Spinal epidural abscess, 245–247 (SONK), 356 Spinal intradural infections, 245 Sprain, definition of, 4 Spinal muscular atrophy, 314 Sprengel’s deformity, 294 Spinal shock, 228, 323 Spring ligament, 207 Spinal stenosis, 236, 286 Spur sign, 218 definition, 225 Stable intertrochanteric L5 nerve root, 226 fracture, 130 neurogenic claudication, 225 Staphylococcal aureus, 43 shopping cart sign, 226 Static encephalopathy, 271 vascular claudication, 226 Steinberg classification, 140 Spine deformity, 284 Stenosing tenosynovitis, see Spine infections Trigger finger imaging study, 247 Steroids, 24, 58, 122, 139, 162, 195, Pseudomonas, 246 211, 337, 344 risk factors for, 246 Strain, definition of, 4 spinal epidural abscess, 246, 247 Streeter’s syndrome, 296 384 Index

Stress fractures, 6 T bisphosphonate Takuhashi scoring system, 242 medication, 176 Talar neck fractures in female athlete, 176 canale view, 185 higher risk for, 176 extruded talus, 185 lower extremity, 176 Hawkins classification, 185 MRI, 175 Hawkins sign, 186 pain, 175 lateral process, 185 site for, 176 mechanism of, 185 Subfibular impingment, 208 varus talar malunion, 186 Subtalar joint, 213 Talocalcaneal coalitions, 310 Subtrochanteric femur Talo-calcaneal joint, 213 fracture, 176 Tarsal coalition, 202, 207, 310 Subtrochanteric fracture, 131 Tarsal tunnel, 181 Superiomedial calcaneonavicular borders of, 201 ligament, 207 syndrome Superior labrum anterior to causes of, 202 posterior (SLAP) clinical findings, 202 tears conservative treatment, anterior labrum, 36 203 overhead throwing athletes, Dorsiflexion-eversion test, 36 202 surgical pitfall, 36 electrodiagnostic testing, 203 by Tuoheti classification, 35 MRI, 203 Superior peroneal retinaculum surgical decompression of (SPR), 205 tibial nerve, 203 Supracondylar humerus fracture triple compression test, malunion, 294 202 Suprascapular nerve Tendon vs. ligament, 4 compression, 71 Tennis elbow Suprascapular nerve ECRB, 41 entrapment, 71 findings on examination, 41 Swan neck, 118 histopathology of, 41 Swan neck deformity, 95, 335 non-traumatic condition, 41 Sympathectomy, 122 treatment, 42 Sympathetic nerve block, 121 Terrible triad injury, 51, 147 Syndesmotic injury, 183, 184 Tethered cord, 276, 310 Synovitis, 177 Thermography, 121 Systemic lupus erythematosus Thompson test, 195 (SLE) Thoracic kyphosis, 233, 317 antibodies, 353 Thoracolumbar fractures, 233, 234 child-bearing age, 353 Thoracolumbar Injury corticosteroids, 354 Classification and definition, 353 Severity Score hydroxychloroquine, 354 (TLICS), 234 hypercoagulable state, 354 Thrombocytopenia absent radius SLE-related arthropathy, 117 (TAR) syndrome, 296 Index 385

Thumb carpal-metacarpal components, 141 (CMC) joint direct anterior approach, 142 arthritis, 58 direction of hip dislocation, arthroplasty, 34 143 OA, 120 heterotopic ossification Thumb duplications, 296 prevention, 143 Thumb metacarpophalangeal hip extension and external (MCP) joint, 119 rotation, 143 Tibia shaft fractures hip flexion and internal advantages of intramedullary rotation, 143 nailing, 155 intraoperative periprosthetic closed reduction, 153 femur fractures, 142 complication, 154 peroneal branch of sciatic diagnosis of compartment nerve, 142 syndrome, 154 posterior/posterolateral Gustilo-Anderson approach, 142 classification, 154 posterior-superior zone, 143 LEAP study, 154 post-operative periprosthetic procurvatum (apex anterior) femur fractures, 142 and valgus, 153 risk of dislocation, 143 techniques, 154 Vancouver classification, 142 treatment, 155 Total knee arthroplasty (TKA), Tibial nerve, 201–203 3, 167 Tibial plateau fractures causes of failure, 167 Ankle-Brachial Index, 173 constrained and compartment syndrome, 174 unconstrained implant, CT scan, 174 168 joint alignment and stability, constrained implants, 168 174 cruciate retaining implant, knee dislocation, 173 168 knee-spanning external femoral and tibial fixation, 174 components, 166 lateral and medial plating, 174 flexion/extension gaps, 167 Lateral meniscus, 174 gap balancing, 166 Schatzker classification, 173 lateral compartment, 166 Tibial torsion, 163, 251, 252, 299, measured resection, 166 301 patient with history of, 167 Tinel’s sign, 18, 112 periprosthetic fractures, 167 Total elbow arthroplasty, 34, 60 posterior stabilizing absolute contraindications, 56 implant, 168 complication, 56 simple primary, 166 indication for, 56 unconstrained implants, 168 Total hip arthroplasty (THA), 3 with medial approach, 166 acetabulum, Total shoulder cup placement, 142 arthroplasty, 33 bone in-growth fixation, 142 Total wrist arthroplasty, 34 cement fixation, 142 Trabecular microfractures, 175 386 Index

Transcaphoid perilunate Tuoheti classification, 35 dislocation, 85 Type II Arnold-Chiari Transient osteoporosis of hip malformation, 275 (TOH), 356 Type 2 fracture, 231 Transverse atlantal ligament (TAL), 231 Trapezial body fractures, 84 U Trapezial ridge fractures, 84 Ulna shaft fracture Trapezium fractures, types of, 84 complications, 62 Trauma, 13–14, 355 ipsilateral elbow and wrist Traumatic digit amputations, see radiographs, 61 Revision finger nonoperative treatment, 62 amputation restoration of the radial bow, Traumatic lower extremity injury, 62 11 sugartong, 61 Traumatic paralysis, 314 Ulnar collateral ligament (UCL), Traumatic unilateral shoulder 89 dislocations (TUBS), Ulnar nerve, 43 31 decompression, 70 Trendelenburg gait, 127, 265 transposition, 70 Triangular fibrocartilage complex Ulnar neuropathy, 60 (TFCC) tears, 17, 66 Ulnohumeral arthroplasty, 60 classifications, 102 Ulnotrochlear joints, 55 components, 101 Unhappy triad injury, 147 diagnosis, 102 Unstable intertrochanteric imaging study, 102 fracture, 130 surgical options, 102 Upper extremity arthroplasty symptoms and physical exam, MCP joint replacement, 34 101 reverse total shoulder X-ray views, 101 arthroplasty, 33 Trigger finger thumb CMC arthritis, 34 medical conditions, 80 total elbow arthroplasty, 34 nonsurgical method, 80 total shoulder arthroplasty, 33 Notta’s node/nodule, 80 total wrist arthroplasty, 34 palmar aponeurosis pulley, 80 Upper extremity dislocation, pediatric, 79 type of, 9 radial digital nerve to the Upper extremity physical exam thumb, 80 anterior interosseous nerve, symptoms, 79 18 Triple compression test, 202 cubital tunnel syndrome, 18 Triquetrum fracture De Quervain’s tenosynovitis, fracture mechanism, 83 17 treatment, 84 Durkan’s carpal compression Trisomy 21, 289 test, 18 Trochlear dysplasia, 163 glenoid labrum, 17 TT-TG distance, 164 supination, 17 Index 387

TFCC, 17 W ulnar artery and radial artery, Waddell signs, 236 17 Wagner ulcer scale, 198 Uveitis, 342 Wagstaff fragment, 194 Warm complex regional pain syndrome, 121 V Warm ischemia, 115 VACTERL association, 296, 315 Wassel classification, 296 Valgus, definition of, 4 Water immersion Vancouver classification, 142 testing, 112 Varus, definition of, 4 Weight bearing as tolerated Vascular claudication, 226 (WBRT), 3 VATER syndrome, 289, 296 Windswept pelvis, 216 Vertebral compression fracture, 234, 346 Vertebral osteomyelitis, 245, 247 X Vertical shear (VS), 215, 216 X-ray, 5, 6, 14, 25, 62, 87, 101, 103, Vitamin D, 347 160, 165, 178, 185, 186, Volar approach of Henry and 205, 215, 217, 223, 247, dorsal (Thompson) 254, 300, 321, 324, 348, approach, 62 356 Volar intercalated segmental instability (VISI), 103 Volar plate, 10 Y V-Y flap, 99 Young-Burgess classification, 215