patellar dislocation orthobullets

Proximal Tib-Fib Dislocation Knee Overuse injuries Patellar Tendinitis A traumatic rupture of the patellar tendon caused by a tension overload during activity in a patient at risk. Treatment for Cauda Equina Syndrome in contrast is emergent microdiscectomy within 48 hours. Caused by mutation(s) in the EXT1/EXT2/EXT3 genes, Exostoses grow towards the joint in MHE but away from the joint in solitary osteochondromas, The most common joint affected is the knee, The rate of transformation to chondrosarcoma is less than 10% in MHE. depends on metaplastic bone (fibrocartilge) for successful results. He reports no night pain or constitutional symptoms. The sciatic nerve was well visualized and protected during the procedure. When the knee bends and straightens, the patella moves straight up and down within the groove. (OBQ11.65) (OBQ09.111) Which of the following procedures would most effectively improve forearm rotation in this patient? Examination reveals positive ipsilateral and contralateral straight leg raise at 30 degrees. Treatment is observation for genu valgum <15 degrees in a child <7 years of age. He is also noted to have a grade 1 splenic laceration and lung contusion. He has noticed intermittent episodes of gait imbalance and difficulty with buttoning his shirt over the past 3 months. The atlantoaxial joint is an important "transitional zone" in the cervical spine. Adult Dysplasia of the Hip is a disorder of abnormal development of the hip joint resulting in a shallow acetabulum with lack of anterior and lateral coverage. Based on the radiograph shown in Figure 4, the innervation of what muscle is most at risk with total hip arthroplasty? He says he required surgery for removal of these bony prominences when he was younger. PT to strengthen the dynamic stabilizers of the neck, Soft collar wear during any athletic activities, Cessation of all contact sports with no surgical intervention, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, C1-C2 Fixation with lateral masses and pedicular screws and rods and use of titanium cages. Radiographs show a Tonnis angle of 15 degrees and a lateral center-edge angle of 15 degrees. She has a positive straight leg raise on the right. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. During surgery there is no evidence of instability. 10/18/2019. Osteochondromas are benign chondrogenic lesions derived from aberrant cartilage from the perichondral ring that may take the form of solitary osteochondroma, or Multiple Hereditary Exostosis. Surgical resection is indicated in cases of progressive and severe pain. Which of the following is the most appropriate surgical treatment? What structure is located at the tip of the arrow in Figure 18? Copyright 2022 Lineage Medical, Inc. All rights reserved. (SBQ18SP.62) Genetic work-up reveals a defect in the EXT-1 gene. MRI scans are shown in Figures A and B. Orthobullets Team Pediatrics - Genu Valgum (knocked knees) Listen Now 11:53 min. Hyperextension of the femoral component. (OBQ10.29) Neutral and flexion radiographs are shown in Figures A and B. Copyright 2022 Lineage Medical, Inc. All rights reserved. Treatment for radicular leg pain is initially nonoperative with oral medications and physical therapy. (OBQ20.115) Copyright 2022 Lineage Medical, Inc. All rights reserved. Traumatic Spondylolisthesis of Axis (Hangman's Fracture), Cervical Lateral Mass Fracture Separation, Extension Teardrop Fracture Cervical Spine, Clay-shoveler Fracture (Cervical Spinous Process FX), Chance Fracture (flexion-distraction injury), Osteoporotic Vertebral Compression Fracture, Ossification Posterior Longitudinal Ligament, DISH (Diffuse Idiopathic Skeletal Hyperostosis), Atlantoaxial Rotatory Displacement (AARD), Pediatric Intervertebral Disc Calcification, Pediatric Spondylolysis & Spondylolisthesis. Copyright 2022 Lineage Medical, Inc. All rights reserved. A sagittal CT scan is shown in Figure C with a coronal reconstruction shown in Figure D. What is the most appropriate treatment? Nerves . This is an AAOS Self Assessment Exam (SAE) question. On physical exam he has weakness to knee extension, numbness over the medial malleolus, and a decreased patellar reflex. Femoral head within acetabulum despite some subluxation. Partial tears may need an MRI to confirm the diagnosis. (SAE13HK.10) 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. (OBQ12.102) Orthobullets Team A representative MRI cut is shown in Figure A. What femoral characteristic is a typical concern in this patient? Again the (25 times) tamping was done with the rod. (OBQ10.254) Mutations in the tumor suppressor genes EXT1 and EXT2 gene leads to a condition characterized by which of the following images. Flexion and extension radiographs show no evidence of spondylolisthesis. A 47-year-old man presents for consultation for "potential spine surgery" after referral from his chiropractor. exacerbating activitis include hip flexion or external rotation in weight bearing stance, lateral hip pain and a limp or Trendelenburg gait may occur with abductor fatigue, evaluation of gait; abductor fatigue or Trendelnburg sign, overall ligamentous laxity; Beighton score, increased internal rotation with the hip in flexion, lateral decubitus position, hip placed in extension as examiner applies progressive external rotation and adduction, anterior-directed force on the posterior greater trochanter, lateral center-edge angle (LCEA) of Wiberg, assesses superolateral coverage of the femoral head on the AP view, angle between a verticle line through the center of the femoral head and the acetabular edge, inclination of the weight bearing portion of the acetabulum, angle formed between the horizontal and a line along the superior acetabulum, assesses anterior coverage of the femoral head, angle created between a vertical line through the center of the femoral head and the anterior acetabulum, >40 indicative of femoroacetabular impingement (FAI), Femoro-Epiphyseal Acetabular Roof (FEAR) index, angle formed between the horizontal portion of the central proximal femoral physeal scar and the acetabular index, FEAR index <5 indicative of a stable hip not requiring treatment, should only be ordered by treating surgeon, adequate assessment of acetabular and proximal femoral osseous morphology including excessive anteversion or retroversion, distal femur should be included in patients with clinical signs of femoral anteversion, diameter of femoral canal may be over-estimated on AP radiographs and underestimated on lateral radiographs due to rotational mismatch of the metaphysis and diaphysis, Identification and prevention of infantile developmental dysplasia (DDH), Pavlik harness, closed and open reductions, spica casting, proximal femoral osteotomies, role of long-term nonsurgical management in symptomatic dysplasia is limited given premature progression of secondary OA, adjunct procedure to PAO for enhanced visualization and management of chondral, labral and proximal femoral cam-type lesions, contraindicated in the setting of moderate to severe dysplasia, chondral and labral pathology is a sequelae of osseous instability and may recur or progress if underlying pathology is not corrected, associated with accelerated progression of arthritis, hip subluxation, less functional improvement, as well as increased risk of surgical failure and reoperation, intraoperative dynamic testing of hip motion is needed to determine the need for femoral osteotomy, minimum of 90 flexion and 15 internal rotation to prevent FAI, preserved integrity of the posterior column, which allows patients to weight bear as tolerated postoperatively, reliably improves radiographic parameters and symptomatology, 92% survivorship at 15 years in avoiding THA, recommended for patients with inadequate femoral head coverage and, 84% survivorship at 17 years with advanced OA as an endpoint, advanced DDH and asphericity of the femoral head associated with poor outcomes, can be used for Crowe type I or II disease, higher revision and complication rate with hip resufracing in patients with DDH compared to general population, treatment of choice for patients with end-stage OA secondary to dysplasia, outcomes for Crowe I and II patients are in similar to those of THA for primary OA in the short term, revision rates for Crowe III and IV are higher than non-dysplastic hips, long term follow up demonstrates a higher revision rate for THA in dysplastic hips, increased complication profile: infection, instability and neruovascular injury, risk of sciatic nerve injury if limb length changed by >4cm, may need to perform femoral shortening (trochanteric or subtrochanteric), weight loss, NSAIDs, activity modification, intra-articular injections, should not be performed in isolation as it does not treat underlying pathologic cause, hip arthroscopy performed concomitantly with PAO to address labral pathology or evaluate for chondral injuries, if significant chondral injury is identified, PAO can be abandoned with minimal morbidity, involves osteotomies in the pubis, ilium, and ischium near the acetabulum, allows significant three-dimensional correction of the acetabulum, hip arthroplasty performed after PAO may lead to increased incidence of a retroverted acetabular cup, make cut above acetabulum to sciatic notch and shift ilium lateral beyond the edge of acetabulum. What is the most appropriate next step in treatment? common peroneal nerve. patellar tendon. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Anterior.Isolated anterior knee pain suggests involvement of the patella, patellar tendon, or its attachments. (SBQ07SM.42) A 14-year-old male sprinter felt a pop and began to experience immediate left hip pain while participating in the 400-meter dash. Surgical management is indicated for severe and progressive genu valum in a child > 7 years of age. (SAE07HK.32) Radiographs are shown in Figure A. Which physical exam finding would suggest peroneal nerve palsy instead of L5 radiculopathy? Spine Infections, Tumors, & Systemic Conditions. There is a small patch of diminished sensation on the dorsum of the foot. iliotibial band . Place all the apparatus parts together. Which of the following radiographs (Figures A-E) is consistent with a disorder that is inherited in an autosomal-dominant inheritance pattern? He denies any recent trauma. L4/5 microdiskectomy through midline approach, L4/5 microdiskectomy with far lateral Wiltse approach, L4/5 Decompression, TLIF, and instrumented fusion, L4/5 Decompression, PLIF, and instrumented fusion. This patients radiograph is shown in Figure A. 4/20/2020. Patellar instability is a condition characterized by patellar subluxation or dislocation episodes as a result of injury, ligamentous laxity or increased Q angle of the knee. His WBC, LDH, and Alkaline phosphatase are normal. (OBQ06.118) Then done tamping on the first layer (25 times) with the help of the rod. 93 plays. Treatment typically involves periacetabular osteotomies for those with concentrically reduced hips with congruous joint space and total hip arthroplasty for those presenting with end stage osteoarthritis. Which of the following treatment modalities will allow the greatest improvement of physical functioning? (SAE07HK.34) THA Dislocation THA Sciatic Nerve Palsy THA Leg Length Discrepancy Abnormal patellar tracking, although not the most serious, Orthobullets Team Recon - TKA Axial Alignment; Listen Now 10:28 min. knee dislocation. WebStep 1. Typically involving the posterior elements of the cervical spine. Following surgical treatment of a lumbar disc herniations with radiculopathy, patients with worker's compensation claims have which of the following when compared to patients who do not have worker's compensation claims at 5 years? 2% (17/707) 4. physical exam. Team Orthobullets 4 Knee & Sports - Discoid Meniscus; Listen Now 6:33 min. 595 plays. Radiographs are shown in figure A. Step 2. 4% (26/707) 3. An 18-year-old male presents with the radiographs shown in Figures A and B. The diagram in Figure A is included in his intake packet. Diagnosis is made with radiographs showing. Treatment is closed reduction and casting or surgical fixation depending on the degree of displacement. Which of the following radiographs represent typical findings seen with a mutation of the EXT1, EXT2, or EXT3 genes? Multiple hereditary exostosis, chondrosarcoma, Multiple hereditary exostosis, enchondroma, Multiple enchondromatosis, chondroblastoma, Multiple hereditary exostosis, osteosarcoma. Flexion gap instability. (OBQ11.173) A standing alignment radiograph is shown in Figure A. - Matthew Hepinstall, MD, Pro: CT-Guided Robotic Arm Assisted Total Knee Arthroplasty - Matthew Hepinstall, MD, Pro: Image-Free Handheld Robotics In Total Knee Arthroplasty - Jimmy Chow, MD. This patient is more likely to return to play than players of another professional sport. 45-year-old manual laborer presents to the office with acute onset back pain that radiates to his right leg after carrying a heavy object. In rare cases a large disc herniation can lead to Cauda Equina Syndrome which requires emergent diagnosis and treatment. He has mildly diminished big toe dorsiflexion strength on the right side. Osteotomy through the base of the tumor and local wound care. THA Dislocation THA Sciatic Nerve Palsy THA Leg Length Discrepancy THA Vascular Injury & Bleeding THA Chronic Complications THA Aseptic Loosening THA Iliopsoas Impingement TKA Patellar Prosthesis Loosening usually medial-sided plateau fractures . THA Dislocation THA Sciatic Nerve Palsy THA Leg Length Discrepancy preserves patellar tendon and tibial tubercle. (OBQ12.230) A 38-year-old male presents with a three month history of low back pain and right leg pain that has failed to improve with nonoperative modalities including selective nerve root corticosteroid injections. A 35-year-old physical therapist presents with right-sided back and leg pain. The number of games played prior to injury is a positive predictor of ability to return to play following this injury. (OBQ06.105) In the second manuver, keeping the hip flexed, flex the knee and adduct the knee accross the body of the patient, again looking for pain in the the posterior/buttocks region. In patients with lumbar disc herniations resulting in significant unilateral leg pain but no functionally limiting weakness, surgical decompression has what long term effects when compared to nonoperative management? In patients with a symptomatic lumbar disc herniation who have failed nonoperative management, which of the following patient characteristics are associated with improved treatment effects with surgery? He is cleared by the trauma team, and undergoes early total care with reamed femoral and tibial nailing. places extra-articular buttress of bone to the lateral acetabulum over the subluxed femoral head, cover femoral head with fibrocartilage (metaplastic bone), not articular cartilage, posterior approach with release from the piriformis to the gluteus maximus tendon, partial gluteus maximus tendon release aids in exposure, anterior, lateral or posterior based approaches may be used, trochanteric osteotomy may be needed to improve visualization, especially in Crowe type III or IV dysplastics, goal is to place the acetabular component in the true acetabulum to restore normal hip center of rotation and biomechanics, this may cause significant leg lengthening, which would subsequently require femoral shortening (trochanteric or subtrochanteric), components may need to be medialized or used with augments to gain adequate coverage and stability of the acetabulum, can use uncemented cup if there is less than 30% uncoverage, a high hip center can be used to gain adequate bony stability, but is less ideal biomechanically, modular femoral components allow for correction of rotational deformities, increased risk of loosening with a high hip center, increased risk of neurovascular injury and infection, 10 times increased incidence of sciatic nerve palsy (5-15%), lengthening of greater than 4 cm can lead to sciatic nerve palsy that will present clinically as a foot drop, 29% nonunion with greater trochanter osteotomy, subtrochanteric osteotomy and trochanter advancement lowers nonunion rate, increased risks of hip dislocation after arthroplasty (5-10%), especially when high hip center is used, placement of the acetabular component in a high hip position associated with increased risk of loosening, 48% of THA in patients < 50-years-old are a result of dysplasia. (OBQ18.115) A 29-year-old female presents with worsening activity-related groin pain and occasional mechanical symptoms. 73% (518/707) 5. Sagittal and axial MRI images are shown in Figure A and B. may be treated with exostosis excision, ulnar lengthening and radial closing wedge osteotomy. Radiographs are shown in Figures A and B. fracture dislocation . (SBQ16HK.2) Given this patient's presentation and family history, you initially recommend molecular genetic testing. A 45-year-old man presents to clinic with low back and lower extremity pain. Classification. A radiograph taken after the fall is shown in Figure 10b. What is the most appropriate treatment? amplification of neural signaling within the central nervous system (CNS) that elicits pain hypersensitivity. She reports pain along the lateral joint line with vigorous activity. most common age of presentation 3-5 years, distal femur is the more common location of pathological deformity, physiologic progression of coronal alignment, genu valgum will peak at 3-4 years to a tibiofemoral angle of 15-20 degrees, after age 7 valgus should not be worse than 12 degrees of genu valgum, after age 7 the intermalleolar distance should be <8 cm, decreased growth from lateral physis relative to medial physis, lateral femoral condyle growth suppressed predisposing to lateral subluxation, normal lateral distal femoral angle (LDFA) = 85-90 degrees, normal medial proximal tibia angle (MPTA) = 85-90 degrees, hypoplastic lateral femoral condyle with shallow lateral femoral sulcus, composed of meniscofemoral and meniscotibial ligaments, increased combined lateral vector of quadricep and patellar tendon (increased q-angle), branch off sciatic nerve that winds laterally around fibular neck, innervates lateral compartment of leg which controls eversion of foot, innervates anterior compartment of leg which controls dorsiflexion, center of femoral head to center of ankle should pass through center of knee, lateral deviation of mechanical axis in genu valgum, lateral femoral condyle and lateral tibia, mechanical loading on physis modulates growth, greater proportion of change in growth rate from hypertrophic zone (75%) than proliferative (25%), greater effect on growth seen from change in size of chondrocytes than number, Physiologic genu valgum must be differentiated from pathologic causes, Chondroectodermal dysplasia (Ellis-van Creveld), medical and family history can help differentiate between physiological and pathological etiology, apparent genu valgum with excessive femoral anteversion or external tibial torsion, general exam to assess stigmata of associated conditions, excessive genu valgum clinically age group beyond which is expected of physiologic changes, patella should be facing forward to ensure proper positioning, lateral deviation of mechanical axis through knee, depends on suspected underlying medical conditions, urinalysis for excess muscopolysaccharides (ie keratan sulfate - Morquio), vast majority of physiological genu valgum will resolve spontaneously, medical management of underlying etiology may slow progression, bracing may provide temporary relief but is an ineffective long-term solution, intramalleolar distance of 10 cm after age 10 Equal limb pain and equal functional outcomes, Improved limb pain and improved functional outcomes, Worsened limb pain and worsened functional outcomes, Worsened limb pain but improved functional outcomes, Improved limb pain but worsened functional outcomes. Patellar maltracking occurs as a result of imbalance of this relationship often secondary to anatomic morphologic abnormality. Which of the following is true? 10/19/2019. (OBQ10.18) L3/L4 far lateral (foraminal) disc herniation, L4/L5 far lateral (foraminal) disc herniation, L5/S1 far lateral (foraminal) disc herniation. He requires a shoe lift to ambulate. After a failure of nonoperative treatment, which of the following is the most appropriate surgical treatment? Thank you. WebPatellar tracking refers to the dynamic relationship between the patella and trochlea during knee motion [ 1 ]. (SBQ16HK.2) A 65-year-old male presents to your office for evaluation of chronic debilitating left hip pain over the last 5 years. Worse outcomes in pain, physical function, and return to work status at 4 years. Which of the following clinical scenarios would best produce this pattern of symptoms? His primary care physician initially diagnosed the lesion as a wart and it was unsuccesfully treated with a topical salicylic acid preparation. what is your provisional? Her new radiograph and MRI images are shown in Figure A and B respectively. Ten months later he re-develops similar symptoms of leg pain. provides excellent detail of bony anatomy and can confirm pelvic ring/acetabular fractures that are not always visible on plain radiographs. You can rate this topic again in 12 months. Worse outcome in return to work status with equivalence in pain and physical function at 4 years. Her medical history is positive for asthma and eczema. On strength testing, he has graded 5/5 strength to knee extension, 6/4/2020. On physical examination, he has pain with flexion, adduction, and internal rotation of the right hip and reports deep-seated groin pain when asked to perform a squat. Webpatella tracking (Figure 1 left). Osteochondroma & Multiple Hereditary Exostosis. Neoadjuvant chemotherapy followed by surgical excision with subsequent adjuvant chemotherapy, Observation with serial radiographs every 6 months, Nail removal and surgical excision of the lesion. Improved outcome in return to work status only at 4 years. Prior to this she had had 1 month of low back pain. Which of the following is true of patients who undergo hip arthroscopy in the presence of this underlying pathology as compared to those without? Which of the following would most likely explain this clinical presentation. 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