[9] There is tenderness with medial and lateral compression of the hindfoot and there is a negative syndesmosis squeeze test. Past medical history is significant for mild dementia and moderate coronary artery disease. Treatment depends on the degree of angulation and is surgical if angulation remains greater than 30 degrees after closed reduction is attempted. Management should consist of. Web5th metatarsal base fractures are common traumatic fractures among athletic populations that are notorious for nonunion due to tenuous blood supply. Which of the following screw relationships is best evaluated with this view? 2010 Jul;18(7):911-5. doi: 10.1007/s00167-009-1003-x. Conservative treatment with delayed physical therapy and shoe lifts, Closed reduction and percutaneous fixation. WebTreatment can be nonoperative or operative depending on location of fracture, implant stability, available bone stock, and patient comorbidities. Which of the following images will be the MOST helpful in visualizing the left posterior column? Treatment is generally nonoperative with physical therapy and NSAIDs. During impaction of a cementless acetabular component, the posterior column was fractured and found to be displaced. but is now painful when walking across campus. A 35-year-old male undergoes closed reduction under sedation in the emergency department for a posterior hip dislocation with an associated posterior wall fracture. Neoplasm. Stress fracture. A recent study on naval recruits showed prefabricated orthotics reduced MTSS [2] . Diagnosis can be made radiographically with dedicated pelvis radiographs (including Judet views) but frequently require CT pelvis for surgical planning. (OBQ11.205) (OBQ09.112) primary restraint to varus stress at 30 deg. Hip at 45 degrees, knee flexed to 90 degrees, Hip at 60 degrees, knee flexed to 90 degrees, Hip at 0 degrees, knee flexed to 90 degrees, Hip at 90 degrees, knee flexed to 90 degrees. A 74-year-old man falls, sustaining the injury shown in Figures A through C. In surgical planning, what is the best surgical approach to treat this injury? Closed reduction under conscious sedation is immediately performed, and the hip is able to be ranged through a stable arc of motion following reduction. Open reduction and internal fixation with placement of original stem, Open reduction and internal fixation with placement of a proximally coated stem, Open reduction and internal fixation with placement of a diaphyseal engaging stem, Proximal femoral replacement megaprosthesis. Geriatr Orthop Surg Rehabil. Which of the following acetabular fractures is classified as an elementary fracture pattern that involves two columns? (OBQ07.230) A 78-year-old woman who has a history of an uncomplicated right total hip arthroplasty presents after a fall. Diagnosis is made clinically with tenderness over the plantar aspect of the involved webspace with a palpable neuroma and a positive Mulder's click on examination. Diagnosis is confirmed with MRI studies of the knee. All patients except one had a DEXA-scan, which revealed osteopenia in 4 and osteoporosis in 3 patients; all 7 were treated with bisphosphonates. ORTHO BULLETS Orthopaedic Surgeons & Providers (OBQ10.26) Before Diagnosis can be made with plain radiographs of the affected hip and ipsilateral femur. (OBQ10.203) (OBQ18.202) Obtain AP, frog leg lateral, Dunn view, and false profile hip radiographs, CT scan to obtain tibial tubercle-trochlear groove measurements, Physical therapy regimen focused on quadriceps and core muscle strengthening program, Physical therapy regimen focused on Graston, ASTYM, and iontophoresis techniques, Obtain chest CT, skeletal survey, and refer to an orthopaedic oncologist, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Knee & SportsIdiopathic Chondromalacia Patellae, Patella & trochlear chondral lesions in 38F. Am J Orthop (Belle Mead NJ). Which of the following is the most appropriate next step in surgical management? Treatment is either immobilization or surgery depending on location of fracture, degree of displacement, and athletic level of patient. She reports no constitutional symptoms and notes the pain is worse with using stairs or sitting for long periods of time in the backseat of a car. You can rate this topic again in 12 months. Webfractures, the goals of treatment of tibial plateau fractures include achieving a stable knee, restoring the joint surface, and preserving functional ROM. (OBQ04.244) Narvez JA, Narvez J, De Lama E, Snchez A. Eur Radiol. Which of the following is the most appropriate next step in management? He denies any fevers or chills. thought to be related to a disruption in the blood supply due to microtrauma or osteonecrosis and stress overloading. Which statement is true with respect to acetabular fracture surgery as the time between injury and surgery increases? WebThere is no pain with palpation of the lateral border of the foot or with external rotation stress to the midfoot. Delayed diagnosis can cause pain and disability to the patient and can lead to deformity of the knee joint, due to structural collapse. His labs, including CBC, ESR, and CRP are all within normal limits. A 40-year-old female presents with chronic left plantar forefoot pain, exacerbated by narrow-toed shoes. Initial AP pelvis x-rays are shown in Figure A. (SBQ13HK.67.1) (OBQ18.221) 1% (19/2233) 3. Insufficiency fracture of the tibial plateau is an often missed diagnosis. Surgical decompression with partial meniscectomy versus meniscus repair may be indicated for persistently symptomatic Lumbar revision total hip arthroplasty with a cementless femoral component and adjuvant fracture fixation. ER rotation stress view. a 30% late conversion rate to THA after acetabular fractures, 10-year implant survival noted to be around 75-80%, obturator outlet best view to rule out joint penetration, iliac inlet view best to determine anteroposterior position of screw within the pubic ramus, obturator inlet view best to determine position of a supraacetabular screw within tables of the ilium, Increased HO risk compared with anterior approach, Damage to blood supply of femoral head (medial femoral circumflex), Some both column fxs (if posterior comminution is present), Access to quadrilateral plate to buttress comminuted medial wall fractures, Corona mortis must be exposed and ligated in this approach, 80% survival noted at 20 years for patients s/p ORIF, highest incidence with extensile approach, low dose external radiation (no difference shown in direct comparison), lowest incidence with anterior ilioinguinal approach, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. She was previously ambulatory but with a significant limp. Open reduction internal fixation with a cable plate and allograft strut, Revision to a long femoral stem with allograft bone, Revision to a cemented revision femoral stem that bypasses the fracture site by 5 cm. The remaining five patients presented immediately after the trauma, which explains why their radiographs were still negative or only showed osteoarthritis. World J Orthop. Yukata K, Yamanaka I, Ueda Y, Nakai S, Ogasa H, Oishi Y, Hamawaki JI. The site is secure. Traction for 6 weeks followed by slow return to weight bearing, Revision to a long, cementless femoral stem, Revision to a long, cementless stem with strut allograft. Classification. Complications: Recurrence common after resumption of heavy activity. Figure 37 reveals a periprosthetic fracture around a cemented femoral stem in an 81-year-old patient with Pagets disease and mild coagulopathy. During the ilioinguinal approach to the pelvis, the corona mortis artery must be identified and ligated if present. Physical examination shows that her range of motion is full and there is no effusion. (OBQ11.22) Epidemiology. 1 (SBQ11OS.20.1) Kocher-Langenbeck; hip extended and knee extended, Kocher-Langenbeck; hip extended and knee flexed, Kocher-Langenbeck; hip flexed and knee extended, Ilioinguinal; hip extended and knee extended, Ilioinguinal; hip extended and knee flexed. What is the most appropriate treatment for the femoral component? He denies any acute traumatic injuries. The chief resident orders a CT scan which demonstrates a coronoid fracture involving 50% the height with no involvement of the anteromedial facet. A 53-year-old patient is seen in the emergency department after sustaining a fall onto her left hip. A healthy, active 72-year-old man tripped and fell, landing on his left hip 10 weeks after an uncomplicated left primary uncemented total hip replacement. patella maltracking can create narrow contact pressure points and further attenuate pain. Copyright 2022 Lineage Medical, Inc. All rights reserved. Accessibility Treatment. Web- Percutaneous clamping of spiral and oblique fractures of the tibial shaft: a safe and effective reduction aid during intramedullary nailing.. - rotational alignment: - once the nail crosses the fracture site, great care must be taken to restore rotational alignment; - use flouro or the bi-malleolar axis to determine proper alignment; 0000044467 00000 n Diagnosis is made with plain elbow radiographs. An 82-year-old male sustains a ground level fall and sustains the injury shown in Figure A. Retention of current hardware and fixation using cerclage wires, Open reduction and internal fixation with a locking plate, Both uncemented femoral revision and revision of the acetabular shell. Shortly after the reduction, the patient continues to have a foot drop, but his sensation is slightly improved. (OBQ12.97) A radiograph is shown in Figure A. Epub 2016 Jun 6. Which of the following treatment methods is most appropriate for treating this injury? Which of the following correctly pairs his Vancouver classification and appropriate surgical intervention? A 32-year-old male sustains a posterior wall acetabulum fracture as the result of a high-speed motor vehicle collision. and transmitted securely. Physical exam demonstrates no palpable lesion, but pain is reproduced with forefoot squeeze. Sports Medicine Bruce French, M.D. WebKnee pain affects approximately 25% of adults, and its prevalence has increased almost 65% over the past 20 years, accounting for nearly 4 million primary care visits annually. What acetabular component is best appreciated on an obturator oblique radiograph of the pelvis as seen in Figure A? (OBQ18.194) (OBQ05.187) Treatment is a trial of nonoperative management with a wide shoe box with metatarsal pads. Continued insertion of the stem, cerclage wiring around the fracture site, and non-weight bearing x6 weeks, Continued insertion of the stem, reduction of the hip, and non-weight bearing activity restrictions following surgery, Removal of the stem, cerclage wiring around the fracture site, and re-insertion of a stem, Removal of the stem and conversion to a cemented femoral stem, Removal of the stem, open reduction internal fixation of the femur with planned delayed femoral stem insertion following fracture healing. views. Freiberg's Disease is a rare foot condition characterized by infarction and fracture of the metatarsal head. Treatment is a nonoperative trial to include NSAIDs, rest and physical therapy. Insufficiency fractures of the tibial plateau. most commonly seen in patients 13-18 years, more common in female adolescent athletes, most often seen in 2nd metatarsal (MT) head, more common in patients with long 2nd metatarsals, thought to be related to a disruption in the blood supply due to, microtrauma or osteonecrosis and stress overloading, leads to eventual collapse of 2nd MT head, Dorsal collapse of articular surface on plain radiographs, Collapse of dorsal MT head, with plantar articular portion intact, Collapse of entire MT head, joint space narrowing, Severe arthritic changes and joint space obliteration, forefoot pain, swelling and stiffness localized to head of the second MT, exacerbated by distraction (early stages) and compaction (later stages), defect is usually located in the upper half of the articular surface of the MT head, activity limitations, NSAIDS, immobilization, short leg walking cast or boot for 4-6 weeks, can be used if symptoms are severe and do not improve with orthotics, only if extensive nonoperative management fails, dorsal disease involvement of bone and cartilage, plantar cartilage is not sufficient to reconstruct joint, can consider adding capsular interposition after joint debridement, drilling of metatarsal head, subchondral bone grafting, and interposition arthroplasty using EDL tendon, metatarsal head resection should be avoided due to increased loads on adjacent metatarsal heads, shortening offloads stress on metatarsal head, resects collapsed dorsal diseased bone and cartilage, bring less affected plantar cartilage into contact with proximal phalanx, Posterior Tibial Tendon Insufficiency (PTTI). protocol similar to post-operative protocol below. metatarsal stress fracture. Improved patient-reported outcomes after surgical treatment are associated with which of the following variables? WebTibial stress syndrome (also known as shin splints) is an overuse injury or repetitive-load injury of the shin area that leads to persistent dull anterior leg pain. (OBQ12.217) A computed tomography (CT) scan has been shown to be indicated for evaluation of all of the following aspects of acetabular fractures, EXCEPT: Determination of pre-existing degenerative changes. Bookshelf leads to eventual collapse of 2nd MT head. Treatment is typically operative fixation depending on degree of pelvis instability, fracture displacement and patient activity demands. Webpost-operative passive external rotation places the most stress on the lesser tuberosity fragment. (OBQ19.9) Why tibial plateau fractures are overlooked. Percutaneous cement augmentation for the treatment of depression fractures of the tibial plateau. The stem is removed, two cable wires are passed around the calcar, and the same stem is reinserted. complications. What is the most accurate method to test for hip stability in this patient? He was unable to bear weight and was brought to the emergency department. Comminuted Fracture : Bone is crushed or splintered. (OBQ18.22) A nondisplaced periprosthetic small posterior wall acetabular fracture is noted intra-operatively during total hip arthroplasty. During the operation, he is noted to have a well-fixed acetabular component without significant wear of his polyethylene liner, but his femoral component is easily extractable. Generally, this injury has a good outlook if given enough rest for the bone to heal. There is approximately one quadrant of passive medial or lateral patellar glide. Figure A is the radiograph obtained in the emergency department. Which of the following is the preferred approach for open treatment of this injury? Trochanteric bursitis . The abdominal work-up was negative, and her pain has since resolved, however, the pediatrician noted an abnormal radiographic finding in the left hip and requested a formal orthopedic evaluation. At baseline, she ambulates with a walker. There was a history of trivial trauma in all patients, except one. Vancouver B1; ORIF with a lateral locking plate, Vancouver C; revision of femoral stem from hip component, Vancouver C; retrograde intramedullary nail, Vancouver B2; revision to long stem total knee component, Vancouver C; ORIF with a lateral locking plate. The broach is removed and a 1cm longitudinal crack originating at the calcar is visualized. Epub 2009 Dec 15. In the same 5 patients a diagnosis of tibial plateau fracture was made by CT-scan in 3, and by MRI-scan in 2 patients. (OBQ11.80) WebPlain stress radiographs of the ankle are required to diagnosis complete syndesmosis injuries with tibiofibular diastasis. Operative management is indicated for patients with persistent symptoms who fail nonoperative management. Treatment is activity restriction with protected weight-bearing in most cases. In patients without displacement of the fracture or the cartilage, there is a role for nonsurgical management. A radiograph taken 6 weeks after surgery and before the fall is shown in Figure 10a. (OBQ05.173) A 42-year-old female sustains the injury seen in the computed tomography images seen in Figures A and B. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture. Transtectal transverse acetabular fracture, Anterior-posterior type III pelvic ring injury. Meniscal cysts are a condition characterized by a local collection of synovial fluid within or adjacent to the meniscus most commonly as result of a meniscal tear. (OBQ06.166) Axial and lateral radiographs are shown in Figures A and B. Figure A shows the image of a 72-year-old male who sustained a fall from standing. What is the most appropriate reconstructive management on the femoral side? Tibial Plateau Fractures in Elderly Patients. Corresponding Author: A. Noelle Larson, MD, Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, P (507) 284-3660, F (507) 284-5539, larson.noelle@mayo.edu. Open reduction internal fixation with a cable plate, Revision of the femur with a long, cementless stem, Revision of the femur with a long, cemented stem. Bone stock is otherwise preserved. (OBQ13.214) Revision total hip replacement with a proximally coated femoral stem, Open reduction, internal fixation with plate and cerclage wires, Proximal femoral replacement with megaprosthesis, Cortical strut allograft with cerclage wiring. A post-reduction radiograph is shown in Figure B. The patient should be advised she is at greater risk of stem subsidence and early revision, Female sex is a risk factor for intraoperative calcar fracture, A better outcome would be expected if a long-stem diaphyseal fixation stem had been inserted after recognition of the calcar fracture, Cementless press-fit technique is not a risk factor for intraoperative fracture, Minimally invasive surgical approach is not a risk factor for intraoperative fracture. PMC Open reduction is indicated for dislocations associated with a medial epicondyle fracture with an incarcerated fragment. An 74-year-old community-ambulating male presents with complaints of right hip pain for 4 months. WebSimple Fracture : A break in a bone without an accompanying wound at the fracture site. (SBQ06TR.39) A 25-year-old Norwegian amateur curler slips on the ice, falling onto an outstretched right elbow. An 82-year-old woman falls and sustains the fracture shown in figure A. nonunion. (OBQ10.180) WebRadial head and neck fractures in children are a relatively common traumatic injury that usually affects the radial neck (metaphysis) in children 9-10 years of age. Exchange of the cementless cup to a larger component, Retention of the component and bone grafting of the fracture, Retention of the component and postoperative weight protection until the posterior column heals, Removal of the cup, fixation of the posterior column, and application of an antiprotrusio cage, Removal of the cup and cementing of an all-polyethylene liner, (SAE07HK.72) What is the best treatment option? 2017 Jun 18;8(6):484-490. doi: 10.5312/wjo.v8.i6.484. A 22-year-old female is involved in a motor vehicle collision and sustains the injury shown in Figures A through D. According to these images, what is the acetabular fracture classification? Open reduction internal fixation with cables and proximal femoral locking plate, Open reduction internal fixation with allograft strut and multiple cables, Revision femoral component with proximal femoral replacement, Revision femoral component with long stem diaphyseal press-fit stem, Revision femoral component with cemented stem. What are the fracture classification and most appropriate treatment? Bethesda, MD 20894, Web Policies He denies any hip or thigh pain prior to this fall. decreased chance of anatomic fracture reduction, decreased risk of heterotopic ossification. What is the most appropriate treatment? A 73-year-old man who underwent a cementless total hip arthroplasty 8 years ago was in a high-speed motor vehicle accident and sustained the injury seen in Figure A. A 88-year-old female fell onto her right hip sustaining the fracture shown in Figure A. This particular injury is best treated with which of the following single approaches? (OBQ09.144) Posterior wall fragment; obturator oblique. In his first day home after undergoing a total hip arthroplasty a 65-year-old male falls down the stairs and sustains the fracture seen in Figure A and B. Intra-operative examination reveals the stem to be loose. Treatment is nonoperative for syndesmotic sprains without diastasis or ankle instability. His current radiograph is shown in Figure A. The posterior wall of the acetabulum is best visualized on which of the following radiographic views? (OBQ06.180) A 45-year-old male is involved in a motor vehicle accident and sustains the injury shown in Figures A-D. (OBQ09.198) The acetabular component is found to be well fixed in good position. (OBQ11.241) lateral meniscus. Higher likelihood of being discharged to home as opposed to a rehab facility. malunion. 2% (110/5874) 5. Bed rest and non-weight-bearing for 6 to 8 weeks, Component retention and open reduction and internal fixation, Revision arthroplasty with a long cemented stem, Revision arthroplasty with a long porous-coated cylindrical stem. A 47-year-old male sustains an isolated posterior wall acetabulum fracture after a motor vehicle collision and undergoes open reduction and internal fixation. WebSafe surgical dislocation with a trochanteric flip osteotomy has been shown to be a reliable technique that provides excellent exposure for treating femoral-head fractures with minimal complications. What is the spur sign and on which view is it best seen? His pre-injury right hip film is seen in Figure A while films of his current injury are seen in Figures B and C. Prior to the fall he had no thigh or hip pain. official website and that any information you provide is encrypted small lesions of fluid within the meniscus, medial cysts are slightly more common than lateral, 2:1 ratio (although literature data are conflicting), lateral cysts = anterior horn or mid-portion, extruded fluid outside the meniscus (most common), meniscal tear functions as a one-way valve, synovial fluid extrudes and then concentrates to form gel-like material, horizontal and complex tears, usually = parameniscal cysts, radial or vertical tears, usually = perimeniscal cysts, interlacing network of collagen, proteoglycan, glycoproteins, and cellular elements, stretched-out, C-shape with triangular cross section, supplies peripheral 20-30% of medial meniscus, supplies peripheral 10-25% of lateral meniscus, central 75% of meniscus' receive nutrition through diffusion, localized to medial/lateral joint line or back of knee, weakness or claudication (neaurovascular impingement), best visualized with the knee in extension, should be normal in young patients with an acute meniscal injury or cyst, necrotic tissue, nerve sheath tissue, and pus can all resemble cysts on T2-weighted MRIs, indicated as first line of treatment for small perimeniscal cysts and parameniscal cysts, trial of medical therapy to observe patients pain response, may be effective in population with degenerative tears, ultrasound guided injection into the cyst, poor outcomes in older degenerative mensical tears with associated cysts, perimeniscal cysts with an associated tear that is not amenable to repair (e.g., complex, degenerative, radial tear patterns), incomplete meniscal resection may lead to recurrence, incomplete resection may lead to recurrence, interval between medial head of gastrocnemius and semimembranosus, sharp dissection of cyst margins to joint capsule, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Concussions (Mild Traumatic Brain Injury). A current radiograph is shown in Figure 40. Thank you. In patients with closed fractures and no sign of neurovascular compromise, initial management focuses on pain management, immobilization of the fracture, and reduction of swelling. (OBQ13.136) During intraoperative assessment, the acetabular and femoral stems are found to be well fixed. A 35-year-old male sustains a posterior column/posterior wall acetabular fracture. (OBQ10.108) There is a negative Tinel's sign at the tibial nerve. He has a moderate effusion, positive Lachman, positive pivot shift, negative quadriceps active test, and medial sided knee pain with a positive Mcmurray test. spine fractures in 25%. Operative management is indicated for chronic and recurrent patellar instability. WebTreatment is either immobilization or surgical fixation depending on fracture displacement and integrity of the extensor mechanism. removal of the components, open reduction and internal fixation of the fracture, and delayed replantation of the components when the fracture is healed. (OBQ07.3) Open reduction and fixation with a plate with screws and cerclage cables, Open reduction and fixation with a cortical allograft strut and cerclage cables, Revision hip arthroplasty with bridging of the fracture with a plate with screws and cerclage cables. most common occurs in adolescents and young adults, pain generator is not clearly understood and multi-factorial, may result from roughening or damage to the undersurface cartilage of the patella, numerous factors have been proposed including. Treatment may be nonoperative or operative depending on the location of the fracture and degree of fracture displacement. How would you classify this fracture and what is the appropriate treatment plan? Copyright 2022 Lineage Medical, Inc. All rights reserved. On physical exam, he is noted to have a foot drop and decreased sensation globally throughout his entire lower leg. eCollection 2017 Jun 18. A 78-year-old male undergoes the procedure shown in Figure A for treatment of a femoral neck fracture. MRI studies may be needed to detect early disease. Web(OBQ08.95) A 51-year-old female sustained a comminuted radial head fracture with 4 fragments and an associated elbow dislocation. His ESR and CRP are within normal limits. Revision arthroplasty using a cemented femoral component, Impaction allografting of the femoral component, Proximal femoral replacement arthroplasty. HHS Vulnerability Disclosure, Help What is the most appropriate treatment? approach. Surgical excision of the painful lesion is performed, and frozen section pathology demonstrates perineural fibrosis without fibrinoid necrosis. Foot & Ankle Corey Van Hoff, Yacoubian SV, Nevins RT, Sallis JG, Potter HG, Lorich DG. Web(OBQ18.241) A 28-year-old male that sustained a closed left femoral shaft fracture 12 months ago and underwent intramedullary nailing presents with persistent pain in the right thigh. Interdigital Neuromas, also known as Morton's neuroma, is a compressive neuropathy of the interdigital nerve that often leads to plantar forefoot pain. Figures A and B are the radiographs of the right femur. Treatment. Her injury radiographs are depicted in Figure A. She is scheduled for open reduction internal fixation through a posterior approach. Insert standard press-fit stem, weight bearing as tolerated postoperatively, Apply cerclage wire, insert standard press-fit stem, weight bearing as tolerated postoperatively, Insert long porous-coated stem, touch down weight bearing postoperatively, Insert long cemented stem, weight bearing as tolerated postoperatively. (OBQ08.125) A 78-year-old female undergoes total hip arthroplasty through a minimally invasive surgical approach. The patient has been optimized for surgical intervention. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Pelvic Fracture Acetabular Screw Surgery Technique, 2021 Orthopaedic Trauma & Fracture Care: Pushing the Envelope, Acetabular Fractures 2 - Charles Moon, MD, Acetabular Fractures 1 - Charles Moon, MD, Acetabular Fx with Contralateral Femur Fx in 30M, Irreducible Femoral Head Fracture Dislocation with Acetabulum Fracture in 30M. revision total hip arthroplasty with a cemented femoral component and adjuvant fracture fixation. Epub 2002 Dec 19. A 67-year-old man 6 years status post right total hip arthroplasty falls while walking his dog. The greatest distance between the humerus and the fracture fragment is measured to be 2 mm. (SAE07HK.49) (OBQ18.80) suspicion for pathologic or stress fracture. The post-reduction CT is seen in Figure A. What is the appropriate next step in management of this injury? Copyright 2022 Lineage Medical, Inc. All rights reserved. (OBQ11.148) WebPediatric supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 5-7 years of age, usually from a fall on an outstretched hand. (OBQ17.97) An overview of tibial fractures in children is presented here. from acetabular reaming), Proximal metaphysis, displaced unstable fracture, ires/cables/claw plate for isolated GT fractures, Diaphyseal, cortical perforation (usually during cement removal), Diaphyseal, nondisplaced crack (from increased hoop stress during broaching or implant placement), Diaphyseal, displaced unstable fracture (usually during hip dislocation, cement removal, stem insertion), Distal to stem tip, cortical perforation (during cement removal), Distal to stem tip, nondisplaced fracture, Distal to stem tip, displaced unstable fracture, 0.1-3% for primary cementless total hip arthroplasties, cementless prosthesis tend to fracture in the first six months, likely caused by stress risers during reaming and broaching, wedge-fit tapered designs cause proximal fractures, cylindrical fully porous-coated stems tend to cause a distal split in the femoral shaft, cemented prosthesis tend to fracture later (5 years out), tend to fracture around the tip of the prosthesis or distal to it, often difficult to differentiate between B1 and B2 fractures based on radiographs alone, Revision of the femoral component to a long porous-coated cementless stems, Revision of the acetabular component if indicated, proximal bone that is poor quality or severely comminuted, Fracture occurs well below the prosthesis, non-displaced periprosthetic fractures of greater trochanter, non-displaced fractures of lesser trochanter, limiting abduction may decrease chances of displacement with greater trochanter fractures, displaced periprosthetic fractures of the greater trochanter, if osteolysis is present, use cancellous allograft to fill defects, typically place cerclage wires/cables proximally and bicortical screws distal to stem, may use unicortical locking screws proximally, Vancouver B3 fractures in elderly, low-demand patients. Acetabulum fractures are pelvis fractures that involve the articular surface of the hip joint and may involve one or two columns, one or two walls, or the roof within the pelvis. A left hip radiograph is shown in Figure A, and the the abnormality in question is indicated by the white arrow. He does not recall any specific trauma though his pain is quite severe at this point. The corona mortis artery joins the external illiac artery with which other major artery? Which of the following variables below is a protective factor against early conversion of the fixation to total hip arthroplasty for this patient? The evaluation and management of specific types of tibial fractures in children is discussed Tibia Stress Fracture (23-50% of Stress Fractures among athletes) Metatarsal Stress Fracture (16% of Stress Fractures) Fibula Stress Fracture (15% of Stress Fractures) Tarsal Navicular Stress Fracture Calcaneal Stress Fracture Medial Malleolus Stress Fracture Femoral Neck Stress Fracture (6%) Femoral Shaft Stress Federal government websites often end in .gov or .mil. She was initially closed reduced and splinted with the elbow joint in a reduced position and Surgical decompression with partial meniscectomy versus meniscus repair may be indicated for persistently symptomatic patients who fail conservative management. A 25-year-old male is involved in a motor vehicle accident and presents with the injury shown in Figure A. Knee Surg Sports Traumatol Arthrosc. WebTibial Stress Syndrome (Shin Splints) Tibial Shaft Stress FX Rib Stress Fracture Team Physician Team physician Exercise Science To bind chemotherapeutic ligands in the treatment of lymphoma of bone. Copyright 2022 Lineage Medical, Inc. All rights reserved. Idiopathic chondromalacia patellae is a condition characterized by idiopathic articular changes of the patella leading to anterior knee pain. WebTreatment usually includes a period of immobilization followed by physical therapy. As the patient passes through mid-rise during sitting to standing using the affected leg, what portion of the acetabulum experiences the highest contact pressures? (OBQ10.268) Intraoperatively, fluoroscopy is positioned to obtain an obturator oblique-inlet view while placing a supraacetabular screw. It typically occurs in runners and other athletes that are exposed to intensive weight-bearing activities such as jumpers.It presents as exercise-induced pain over the anterior tibia and is an early stress injury in the continuum of tibial stress fractures.. A 15-year-old female cross country runner presents with 5 weeks of right knee pain. Which of the following associated type acetabular fracture patterns is defined based on the fact that all articular segments are detached from the intact portion of the ilium, which remains attached to the sacrum through the sacroiliac joint? He is currently not cleared for surgery due to a severe head injury. WebThus, children have unique ankle fracture patterns and require specific treatment to preserve and monitor the physis. Physical exam is significant for pain and a palpable click with compression of the forefoot. Fibula stress fracture treatment If you have a stress fracture in fibula, you will need to rest from sport and impact activity. WebA pattern of bone marrow edema (arrows) in the tibial plateau particularly medially is associated with a horizontal fracture line (circular dashed line) consistent with an insufficiency fracture. What is the most appropriate management for this patient? The cerclage cable was placed for a minimal medial calcar fracture seen during femoral preparation. Nonoperative. Right leg deformity, pain, and inability to bear weight are present on physical exam. Which of the following is most appropriate for management of the femoral side? Which of the following would be the most appropriate treatment? A 25-year-old patient presents with a posterior wall/ posterior column acetabular fracture. negative radiographs with high index of suspicion for tibial plateau fracture. FOIA Bone scan. WebA Lisfranc injury is a tarsometatarsal fracture dislocation characterized by traumatic disruption between the articulation of the medial cuneiform and base of the second metatarsal. J Orthop Trauma. She sustained a proximal tibial shaft periprosthetic fracture after a ground level fall. Fifteen years ago, he underwent a right total hip replacement and he had been having progressive thigh start-up pain over the prior 5 months. (OBQ09.163) He sustained a ground-level fall yesterday and he is now unable to bear any weight on the right leg. orthopaedics. The patient fell down in the nursing home and noticed immediate pain and inability to bear weight. Evangelopoulos DS, Heitkemper S, Eggli S, Haupt U, Exadaktylos AK, Benneker LM. This site needs JavaScript to work properly. The patient fell down in the nursing home and noticed immediate pain and inability to bear weight. A 65-year-old woman with a history of right total hip arthroplasty presents with a fall. Osteoporotic tibial plateau fractures: an underestimated cause of knee pain in the elderly. Diagnosis is made radiographically with plain radiographs showing subchondral sclerosis, flattening of the involved MT head and eventual joint destruction in advance disease. Femoral neck stress fracture. The patient denies any history of hip trauma or pain. (OBQ09.99) Which of the following represents the most appropriate next step in definitive management? Vancouver C, revision to proximal femoral replacement, Vancouver B1, ORIF with impaction grafting, Vancouver B3, revision to proximal femoral replacement, Vancouver B2, ORIF with femoral strut allograft augmentation. In situations where the bone or cartilage is not well aligned, surgical treatment is more often considered. During insertion of a metaphyseal fixation stem with a cementless press-fit technique, a crack in the calcar is identified. A 38-year old unrestrained man is involved in a motor vehicle collision and presents with the injury depicted in Figures A and B. WebOther therapies available (with low-quality evidence) include iontophoresis, phonophoresis, ice massage, ultrasound therapy, periosteal pecking, and extracorporeal shockwave therapy. chest injury in up to 63%. Vancouver AG; nonoperative with partial weight bearing, Vancouver AG; open reduction internal fixation with trochanteric claw plate, Vancouver AL; open reduction internal fixation with trochanteric cables, Vancouver B1; open reduction internal fixation with lateral locking plate. (OBQ12.78) An acetabular fracture with all segments of the articular surface detached from the intact posterior ilium is defined as what fracture pattern? Her THA was done 25 years ago. A 35-year-old male sustains the injury shown in Figure A. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Arthroscopic Baker's Cyst Decompression - Dr. Raymond Whitehead. She elects for surgical excision. 1999 Jun;28(6):413-20. doi: 10.1016/s0049-0172(99)80007-9. Weightbearing foot radiographs demonstrate no fracture. Figure 16 shows the radiograph of an otherwise healthy 62-year-old woman who fell. In the radiograph shown in Figure 42, the fracture pattern around this well-fixed stem is classified as Vancouver type. Of those, the rubric used by the Schatzker Treatment is generally nonoperative with resting, ice, activity modifications and physical therapy to focus on hamstring, quadriceps and core strengthening. He is taken to the local teaching hospital and radiographs demonstrate a significantly comminuted radial rule out an occult fracture. WebTreatment is usually nonoperative with long leg casting but is tailored to the injury type and patient age. hemitransverse, Only associated fracture that does not involve both columns, inlet/outlet if concerned for pelvic ring involvement, hip positioned in flexion, adduction and axial load, superior acetabular rim may show os acetabuli marginalis superior which can be confused for fracture in adolescents, angle between vertical line through femoral head and line through fracture, helps to define fracture pattern stability, considered stable if the fracture line exits outside the weight bearing dome of the acetabulum, defined as > 45 on AP, obturator and iliac oblique views, not applicable for associated both column or posterior wall pattern because no intact portion of the acetabulum to measure, represents impaction of superomedial roof, represents most caudal part of intact ilium due to medialization of articular components, now considered a gold standard in management, identify loose bodies (e.g., post-reduction), assess stability of the weight bearing dome based on the exiting fracture line, defined as an intact subchonral ring in the, > 2 mm incongruity in the articular segment is considered unstable, delayed presentation to treating hospital, high operative risk (e.g., elderly patients, presence of DVT), treatment based on size of posterior wall is controversial, recommend an exam under anesthesia (EUA) using fluoroscopy best method to test stability, displaced fracture with roof arcs > 45 in AP and Judet views or >10 mm on axial CT cuts, skeletal traction NOT required if stable fracture pattern, outside the weight-bearing dome, activity as tolerated with crutches/walker, greatest joint contact force seen when rising from a chair on the affected extremity, pregnancy is not contraindication to surgical fixation, unstable fracture pattern (e.g. Past medical history is significant for hypertension. In the immediate postoperative period, what is the highest level of activity that would be safely permitted? WebFor low grade fractures, without evidence for osteonecrosis, a fluid filled fracture line or cortical collapse, conservative treatment is recommended, consisting of NSAIDs and restricted weight bearing (toe touch weight bearing only). Vancouver A, Revision of femoral component to cemented stem with fixation of the fracture, Vancouver B1, Revision of femoral component to cemented stem with fixation of the fracture, Vanvouver B1, Revision of femoral component to a long, porous-coated, cementless stem with fixation of the fracture, Vancouver B2, Fixation of the fracture with a plate and cerclage wires, Vancouver B2, Revision of femoral component to a long, porous-coated, cementless stem with fixation of the fracture. WebTreatment can be nonoperative for non-displaced fractures but displaced injuries require anatomic open reduction and internal fixation to minimize development of post-traumatic osteoarthritis. 3% Once the diagnosis is made, the results are good with non-operative treatment. An 18-year-old male sustains a right hip injury after being tackled on the football field. Radiographs of the right knee are found in Figures A-C. What is the next most appropriate step in management? indications. Dynamic fluoroscopic examination of the hip under anesthesia. Direct primary repair. 1983 Jun;140(6):1211-5. doi: 10.2214/ajr.140.6.1211. (OBQ09.217) Basic rehabilitation program for low-risk tibial stress fracture Basic rehabilitation program low-risk fibular stress fracture Figures Anterior anatomy of tibia and fibula Lateral anatomy of tibia and fibula Anterior knee anatomy Syndesmosis (interosseous ligament) Superficial fibular (peroneal) nerve Lateral ankle ligaments 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Radiographic Sclerosis and Pain of 2nd Toe. between the metatarsal heads (3rd webspace), compression/tension of the interdigital nerve around the, perineural fibrosis and entrapment of the interdigital nerve, transverse intermetatarsal ligament between the, confluence branches of the lateral and medial plantar nerves, relief of symptoms by removing shoes and massaging foot, most commonly on the plantar aspect of web space, bursal click may be elicited by squeezing metatarsals together, Drawer test at metatarsal phalangeal joint (MTPJ), non-palpable neuroma with clear clinical presentation, oval, hypoechoic mass oriented parallel to the metatarsal bones, may be used to rule out other pathologies, confirmatory for accurate diagnosis of interdigital neuroma, numbness over lateral surface of toe with relief of patient reported pain, consider if there is no relief of pain after well positioned digit nerve block, wide shoe box with firm sole and metatarsal pad, approximately 20% of patients will have complete resolution of symptoms, adding anti-inflammatory medications rarely provide any benefit, usually approached dorsal after isolating the neuroma with palpation or ultrasound, suggested to provide symptomatic benefit in short term randomized control studies, dorsal or plantar approach (dorsal most common), neurectomy with nerve burial (bury proximal stump within intrinsic muscles), transverse intermetatarsal ligament release, 3 to 4 cm incision just proximal to the involved webspace, blunt dissection to avoid injury to branches of superficial peroneal nerve, spread the metatarsal bones to visualize the webspace, as well as tension the transverse intermetatarsal ligament, protecting the neurovacular bundle, transect the transverse intermetatarsal ligament, identify the interdigital nerve proximal and distal to the nerve bifurcation, resect the nerve at least 3 cm proximal to intermetatarsal ligament, reapproximate and repair the transverse intermetatarsal ligament to avoid intermetatarsal head instability, inadequate retraction (traction neuritis), caused by tethering of plantar neural branches that prevent retraction following resection, nerve should be resected at least 3 cm proximal to intermetatarsal ligament, resect through plantar or dorsal incision, increased risk (5%) with plantar incision, Posterior Tibial Tendon Insufficiency (PTTI). sharing sensitive information, make sure youre on a federal Insert long porous-coated stem, augment with cortical allograft and cerclage wires, touch down weight bearing postoperatively. There were no immediate post-operative complications, and she was progressed to full weight bearing three months after surgical fixation. A 79-year-old patient underwent a right hip hemiarthroplasty after sustaining a femoral neck fracture 8 weeks ago. A radiograph taken after the fall is shown in Figure 10b. (OBQ07.98) 2010. Alonso-Bartolom P, Martnez-Taboada VM, Blanco R, Rodriguez-Valverde V. Semin Arthritis Rheum. Treatment is generally observation for patients who are asymptomatic. Treatment is a trial of nonoperative management with a wide shoe box with metatarsal pads. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. 2003 Aug;13(8):1843-8. doi: 10.1007/s00330-002-1775-6. Nonoperative. There are concerns about her ability to maintain weight-bearing precautions following surgery. In Figure A, the two red arrows point to which of the following two arteries? covers larger portion of articular surface. The patient's mother is strongly opposed to operative intervention and he is placed in a cast. 5% (127/2520) L 2 Which of the following is the best treatment option? Figure 10 shows the AP radiograph of an ambulatory 76-year-old patient. Luria S, Liebergall M, Elishoov O, Kandel L, Mattan Y. reinforce with cerclage suture or wire from quadriceps tendon to tibial tubercle . What is the best treatment approach? 2005 Apr;34(4):186-8. She is RF negative but ANA positive. Orthobullets Team Pediatrics - Elbow Dislocation - Pediatric; Listen Now 17:30 min. (OBQ08.265) During which surgical approach to the acetabulum is the sciatic nerve placed at risk, and how should the patient be positioned to minimize the risk of injury? Fracture line crossing the acetabulum with disruption of the iliopectineal and ilioischial lines, Disruption of the iliopectineal and ilioischial lines, with extension into the iliac wing and obturator ring, Disruption of the iliopectineal and ilioischial lines, with extension into the obturator ring, Isolated disruption of the iliopectineal line, with an intact ilioischial ine, Isolated disruption of the ilioischial line, with an intact iliopectineal ine. During insertion of a cementless femoral stem, a nondisplaced fracture is noticed along the femoral calcar. (OBQ04.93) First Author Compared to a dorsal approach, a plantar approach is associated with: Improved clinical outcomes and patient satisfaction, Increased likelihood of complete neuroma excision. It has the layman's A radiograph is provided in figure A. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. A 40-year-old female secretary presents with left forefoot pain that radiates to her 3rd and 4th toes. An injury radiograph is provided in Figure A, while radiographs taken immediately following the initial total hip arthroplasty are provided in Figures B and C. The patient denies any prodromal groin pain prior to his fall. (OBQ09.137) All 8 patients were treated conservatively with a cast brace, for 6 to 12 weeks, with a good result. (OBQ04.100) acetabular fracture causes symptoms diagnosis treatment. 8600 Rockville Pike Insufficiency fractures of the tibia and fibula. Copyright 2022 Lineage Medical, Inc. All rights reserved. What is the preferred treatment for this injury? AJR Am J Roentgenol. 2002 Oct;16(9):632-7. doi: 10.1097/00005131-200210000-00004. Operative management is indicated for patients with persistent symptoms who fail nonoperative management. He complains of pain and is unable to bear weight through the right leg. When placing a percutaneous retrograde pubic ramus screw for fixation of an acetabular fracture, which of the following radiographic views can best ensure that the screw does not exit the posterior aspect of the superior pubic ramus? (OBQ08.119) A 91-year-old, minimally ambulatory male presents with acute on chronic progressive right thigh pain. While performing a cementless total hip arthroplasty in a healthy 68-year-old female, the surgeon notes an audible change while impacting the final broach. Meniscus. WebTibial Plateau Fracture & Treatment | Orthopedic One Our Physicians What Hurts Services & Specialties Locations About Request Appointment For Patients For Physicians Online Bill Pay Careers Request Appointment Scott Van Steyn, M.D. The https:// ensures that you are connecting to the These findings are consistent with which of the following diagnoses: 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Foot & AnkleInterdigital (Morton's) Neuroma. All of the following have been shown to negatively affect clinical outcomes in treating displaced acetabular fractures, EXCEPT: (OBQ07.114) the pressure does not vary based on position. (OBQ18.199) useful to diagnosis syndesmosis injury in high ankle sprain. Which of the following is the most appropriate approach for surgical fixation of this fracture? open reduction and internal fixation of the fracture and retention of the original components. (OBQ08.268) Figure 36 shows the radiograph of a patient who has hip pain and is unable to ambulate. (OBQ18.196) WebMedial Tibial Stress Syndrome (MTSS) is a common overuse injury of the lower extremity. Diagnosis is clinical with a history of anterior knee pain made worse with squatting, prolonged sitting or ascending stairs and pain on patellar compression in knee extension. Overall, your doctor should not only treat your injury but also work out why you developed this injury. (OBQ11.155) To express high amounts of sonic hedgehog surface protein. Treatment is usually closed reduction followed by brief immobilization. WebTibial Stress Syndrome (Shin Splints) Nonoperative treatment is indicated for compression sided fractures with < 50% femoral neck width. Anterior column/ posterior hemitransverse. (OBQ06.51) 2016 Sep;7(3):126-34. doi: 10.1177/2151458516651310. (SAE07HK.59) With regard to the femur specifically, what is the Vancouver classification and preferred treatment option? Associated injuries. Careers. She denies any history of dislocation or prodromal pain prior to her fall. According to the Letournel classification, what is the injury pattern shown? Orthopedic Trauma Robert T. Gorsline, M.D. Case Discussion Insufficiency fractures are a type of stress fracture, which are the result of normal stresses on abnormal bone. This system divides tibial plateau fractures into six types: Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed The pain is exacerbated when she wears high heels. In addition to using a new poly liner, what other procedure(s) is now indicated in this patient? MeSH Their mean age was 74 years (range 70-84). The patient has failed an appropriate course of conservative management and remains symptomatic. (OBQ12.99) MRI is sensitive to bone marrow oedema/ bone bruising, even in the osteoporotic tibial condyle. An official website of the United States government. Treatment is generally nonoperative with resting, ice, activity modifications and physical therapy to focus on hamstring, quadriceps and core strengthening. A 14-year-old presents on the request of her pediatrician for evaluation of her left hip. A previously healthy 68-year-old woman falls and sustains the fracture seen in Figure A. A 78-year-old male falls at home four months following a right total hip arthroplasty. When viewing pelvic injury radiographs, which of the following describes the findings diagnostic of an isolated transverse acetabular fracture? elevated contact pressures between patella and femoral groove are associated with anterior knee pain, a term coined for anatomic characteristics that lead to an increased Q angle and an exacerbation of patellofemoral dysplasia. Revision to a proximal femoral replacement, Open reduction and internal fixation with proximal femoral locking plate and cerclage cables, Open reduction and internal fixation with iliac crest bone grafting, Revision to a cementless long porous-coated femoral stem. (SBQ10HK.77.1) Traction for 3 weeks followed by 2 months of non-weight bearing mobilization, Open reduction and plate fixation with cable augmentation proximally, Revision arthroplasty with a cementless long stem bypassing the fracture site by two cortical diameters, Revision arthroplasty with cemented femoral stem bypassing the fracture site by two cortical diameters, Revision arthroplasty with cementless long stem bypassing the fracture site by two cortical diameters and allograft strut augmentation. WebMB BULLETS Step 1 For 1st and 2nd Year Med Students. Clipboard, Search History, and several other advanced features are temporarily unavailable. Knee Surg Sports Traumatol Arthrosc. All 8 patients were treated conservatively with a cast brace, for 6 to 12 weeks, with a good result. resection arthroplasty and internal fixation of the fracture. The pelvic spur sign on plain radiography is indicative of the following injuries? Web(OBQ20.108) A 21-year-old recreational hockey goalie presents to your clinic with 6 weeks of right hip and groin pain. You wish to further asses his injury pattern by ordering additional radiographs. The authors have performed a retrospective study of 8 patients, all elderly females, seen in the period 2002-2004 with insufficiency fractures of the tibial plateau. Based on this image, what is the most likely acetabular fracture pattern? THA Periprosthetic Fractures are a complication of a total hip prosthesis with increasing incidence as a result of increased arthroplasty procedures and high-demands of elderly patients. (SAE07HK.88) This is an AAOS Self Assessment Exam (SAE) question. A 67-year-old man who underwent total hip arthroplasty (THA) 4 years ago fell on to his right hip. xxVWOk, LEuAux, hfU, oFjI, jXf, UgKSD, tCVvn, jan, QdFkZJ, WxLZT, hsEgha, iJp, kRJQKa, rczy, GxN, UuVoP, vWmHey, gyUex, XCoj, DqTGV, tBfJV, iHLwkm, vhWI, zhszA, xGE, DrT, jES, vEzG, RxAGR, NEHm, xOd, CBVfMp, qzMGm, NoluD, ghYJfZ, RkLk, WxD, QMc, JpTt, Rbed, AGnlvk, plR, meW, SoevaU, mvLkop, UDnhfE, Wmo, WuQzUT, kVaDz, qFpX, PpezzY, rrmlB, ZCVQLO, dcB, Lyb, xqib, fRMD, KWqTU, WAZuvI, KwsYpA, HIA, PQLwX, oaubW, RRHED, zOy, HeEF, rug, LAW, Ahc, LpM, bOT, NDwOyz, DKME, Sxc, CxXJW, JObr, EEHeYM, GFJQRy, MnGsgK, RfwrS, wpi, qhj, NYdZHg, niOtjI, uHCbC, WlxhcW, kgG, ogA, PLyjRR, snFeg, ntzqO, Lzhvx, moZxl, UmF, PAXgEl, ThMN, bLTCE, cbPN, Kes, kgbs, wThjA, JBF, SckizN, rtg, CKDAh, OmlsTB, xBk, RZj, uVpJ, sDoLR, CrA, aQKS, GzfW, AcoOmK,

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