Orthopaedic Surgery Review
Questions and Answers
THM_Sokolowski_FM.indd MTC 12/19/2008 06:55AM
, Contents
Preface.............................................................................................................................ix
Acknowledgments.........................................................................................................x
Contributors...................................................................................................................xi
1 Spine..................................................................................................................1
2 Trauma Principles and Pelvic Trauma...............................................................32
3 Hip and Femur..................................................................................................41
4 Knee and Tibia/Fibula.......................................................................................59
5 Foot and Ankle.................................................................................................81
6 Shoulder and Humerus...................................................................................112
7 Elbow.............................................................................................................129
8 Hand, Wrist, and Forearm..............................................................................137
9 Pediatric Orthopaedic Surgery.......................................................................183
10 Basic Science..................................................................................................245
11 Orthopaedic Oncology...................................................................................291
12 Rehabilitation.................................................................................................319
13 Rapid Review of Selected Topics.....................................................................327
THM_Sokolowski_FM.indd vii MTC 12/19/2008 06:55AM
,1
Spine
General Knowledge
Intervertebral Disk
1. What two changes occur in the 1. Vessels begin disappearing after the
vascular supply to the disk with aging? age of 10 years
Endplates ossify
2. What is the source of nutrients to the 2. Diffusion through endplates
disk?
3. What two external factors decrease 3. Smoking
endplate permeability? Vibration
4. What factors increase permeability? 4. Exercise
5. How does aging affect the disk’s 5. Decreased collagen content
collagen content?
6. How does aging affect the disk’s fibril 6. Increased fibril diameter and
diameter? variability
7. How does aging affect the disk’s 7. Increased noncollagenous protein
noncollagenous protein?
8. How does aging affect the disk’s pH? 8. Decreased pH
9. Magnetic resonance imaging (MRI): 9. <40 years old: 25%
what are the rates of false-positive >40 years old: 60%
(asymptomatic) findings for patients >60 years old: 90%
<40 years old, >40 years old, and >60
years old?
Biomechanics
10. What is the function of the anterior 10. Anterior column: support
column and the posterior column? Posterior column: tension band
11. An anteriorly placed graft is loaded in 11. Loaded in compression, flexion
which two directions and unloaded in Unloaded in extension, traction
which two directions?
12. What effect does an anterior plate 12. Moves axis of rotation anteriorly
have on the axis of rotation?
13. … on the graft in extension? 13. Loads graft in extension
14. … on the graft in flexion? 14. Unloads graft in flexion
, 1 Spine
15. What is the definition of terminal 15. Moments at ends of a long construct
bending?
16. How can terminal bending be 16. With intermediate fixation points
prevented?
17. How much lumbar torsional resistance 17. Facets: 40%
is provided by facets, disk, and Disk: 40%
ligaments? Ligaments: 20%
18. After a flexion-distraction injury, 18. ALL intact
what is the status of the anterior PLL out
longitudinal ligament (ALL) and
the posterior longitudinal ligament
(PLL disrupted)?
19. Which approach is biomechanically 19. Posteriorly based fusions are superior
superior in this situation? to anteriorly based fusions
Anatomy
20. How are the cervical spine facets 20. Cervical: 45 degrees in the sagittal
oriented in the sagittal plane? plane
21. Compare with thoracic and lumbar 21. Thoracic: vertical in sagittal plane
facet orientation. (essentially in the coronal plane)
Lumbar: sagittally aligned
22. The sinuvertebral nerve originates 22. Sympathetic chain
from which structure?
23. What structures and elements does it 23. Supplies structures within the spinal
supply? canal
Supplies posterior elements
24. What other neurologic structure also 24. Primary dorsal ramus also contributes
innervates the posterior elements? to innervation
25. Pattern of innervation example: the L3 25. L3 innervates the L3-4 facets
nerve root innervates which facets?
26. At which level is the pedicle diameter 26. T5
the smallest?
27. What is the furcal nerve? What is its 27. Peripheral nerve often originating
clinical significance? from L4 nerve root
Can result in variable L4 dermatomal
distribution
Infections and Malignancies
28. Infection versus malignancy: which 28. Infection destroys the disk early
generally destroys the disk? Malignancy usually skips the disk
29. Compare with the effect of 29. Tb skips the disk early, but may
tuberculosis on the disk. involve the disk late
30. What are the earliest plain 30. Disk space narrowing at 7 to 10 days
radiographic findings of infection?
31. What is the natural history of disk 31. Spontaneous arthrodesis
space infection?
32. What are the two usual treatment for 32. Intravenous antibiotics
osteomyelitis? Brace
Questions and Answers
THM_Sokolowski_FM.indd MTC 12/19/2008 06:55AM
, Contents
Preface.............................................................................................................................ix
Acknowledgments.........................................................................................................x
Contributors...................................................................................................................xi
1 Spine..................................................................................................................1
2 Trauma Principles and Pelvic Trauma...............................................................32
3 Hip and Femur..................................................................................................41
4 Knee and Tibia/Fibula.......................................................................................59
5 Foot and Ankle.................................................................................................81
6 Shoulder and Humerus...................................................................................112
7 Elbow.............................................................................................................129
8 Hand, Wrist, and Forearm..............................................................................137
9 Pediatric Orthopaedic Surgery.......................................................................183
10 Basic Science..................................................................................................245
11 Orthopaedic Oncology...................................................................................291
12 Rehabilitation.................................................................................................319
13 Rapid Review of Selected Topics.....................................................................327
THM_Sokolowski_FM.indd vii MTC 12/19/2008 06:55AM
,1
Spine
General Knowledge
Intervertebral Disk
1. What two changes occur in the 1. Vessels begin disappearing after the
vascular supply to the disk with aging? age of 10 years
Endplates ossify
2. What is the source of nutrients to the 2. Diffusion through endplates
disk?
3. What two external factors decrease 3. Smoking
endplate permeability? Vibration
4. What factors increase permeability? 4. Exercise
5. How does aging affect the disk’s 5. Decreased collagen content
collagen content?
6. How does aging affect the disk’s fibril 6. Increased fibril diameter and
diameter? variability
7. How does aging affect the disk’s 7. Increased noncollagenous protein
noncollagenous protein?
8. How does aging affect the disk’s pH? 8. Decreased pH
9. Magnetic resonance imaging (MRI): 9. <40 years old: 25%
what are the rates of false-positive >40 years old: 60%
(asymptomatic) findings for patients >60 years old: 90%
<40 years old, >40 years old, and >60
years old?
Biomechanics
10. What is the function of the anterior 10. Anterior column: support
column and the posterior column? Posterior column: tension band
11. An anteriorly placed graft is loaded in 11. Loaded in compression, flexion
which two directions and unloaded in Unloaded in extension, traction
which two directions?
12. What effect does an anterior plate 12. Moves axis of rotation anteriorly
have on the axis of rotation?
13. … on the graft in extension? 13. Loads graft in extension
14. … on the graft in flexion? 14. Unloads graft in flexion
, 1 Spine
15. What is the definition of terminal 15. Moments at ends of a long construct
bending?
16. How can terminal bending be 16. With intermediate fixation points
prevented?
17. How much lumbar torsional resistance 17. Facets: 40%
is provided by facets, disk, and Disk: 40%
ligaments? Ligaments: 20%
18. After a flexion-distraction injury, 18. ALL intact
what is the status of the anterior PLL out
longitudinal ligament (ALL) and
the posterior longitudinal ligament
(PLL disrupted)?
19. Which approach is biomechanically 19. Posteriorly based fusions are superior
superior in this situation? to anteriorly based fusions
Anatomy
20. How are the cervical spine facets 20. Cervical: 45 degrees in the sagittal
oriented in the sagittal plane? plane
21. Compare with thoracic and lumbar 21. Thoracic: vertical in sagittal plane
facet orientation. (essentially in the coronal plane)
Lumbar: sagittally aligned
22. The sinuvertebral nerve originates 22. Sympathetic chain
from which structure?
23. What structures and elements does it 23. Supplies structures within the spinal
supply? canal
Supplies posterior elements
24. What other neurologic structure also 24. Primary dorsal ramus also contributes
innervates the posterior elements? to innervation
25. Pattern of innervation example: the L3 25. L3 innervates the L3-4 facets
nerve root innervates which facets?
26. At which level is the pedicle diameter 26. T5
the smallest?
27. What is the furcal nerve? What is its 27. Peripheral nerve often originating
clinical significance? from L4 nerve root
Can result in variable L4 dermatomal
distribution
Infections and Malignancies
28. Infection versus malignancy: which 28. Infection destroys the disk early
generally destroys the disk? Malignancy usually skips the disk
29. Compare with the effect of 29. Tb skips the disk early, but may
tuberculosis on the disk. involve the disk late
30. What are the earliest plain 30. Disk space narrowing at 7 to 10 days
radiographic findings of infection?
31. What is the natural history of disk 31. Spontaneous arthrodesis
space infection?
32. What are the two usual treatment for 32. Intravenous antibiotics
osteomyelitis? Brace
