You discuss treatment options of acetabular revision if the component is found to be loose intra-operatively versus isolated polyethylene exchange if the acetabular component is stable intra-operatively with the patient. Starting point in Figure B with blocking screw in Figure D, Starting point in Figure B with blocking screw in Figure E, Starting point in Figure C with blocking screw in Figure D, Starting point in Figure C with blocking screw in Figure E, Starting point in Figure C with blocking screw in Figure F. (SBQ12TR.17) bony constraint of groove is the primary constraint to lateral patellar instability when knee flexion is > 30 degrees. An 11-year-old soccer player presents with a 6 month history of snapping and discomfort along the lateral joint line of the knee. A radiograph is provided in Figure A. Figures A through E are paired diagrams depicting the anteroposterior and lateral profiles of the proximal tibia. The lower third culminates in the apex which serves as the origin of the patellar ligament. She has now dislocated posteriorly 3 times, each followed by closed reduction under anesthesia in the operating room. posterior knee pain. [9] In 2017 it was discovered that frogs have kneecaps, contrary to what was thought. A Trendelenburg gait would most likely be caused by which of the following lumbar conditions. The tests include, a. Superficial - pain with light touch to skin, b. Which of the following is true of his pathology? (SBQ16SM.13) Previously, bipartite patellas were explained as the failure of several ossification centres to fuse, but this idea has been rejected. He denies any acute traumatic injuries. A patella baja is a low-riding patella. will show patella baja. What technique can be utilized to avoid the characteristic deformity seen in this fracture pattern if an intramedullary nail is used for treatment? Modified Bohlman Technique: Multi-Surgeon Results - Robert Hart, M.D. An AP radiograph of the knee is shown in Figure A. Webquadriceps tendon rupture is more common than patellar tendon rupture. WebTKA Patellar Prosthesis Loosening lateral femoral cutaneous nerve paresthesias. You can rate this topic again in 12 months. Agenesis of the anterior cruciate ligament. Webfracture dislocation . Tendons. Webknee dislocation. 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 A 34-year-old man is involved in a motorcycle accident and sustains a closed tibia fracture and multiple rib fractures. What is the best treatment for this patient? (OBQ06.18) Anatomy. Owing to the great stress on the patellofemoral joint during resisted knee flexion, the articular cartilage of the patella is among the thickest in the human body. WebOrthobullets Team Knee & Sports - Patellar Instability Technique Guide. What is the most common complication of isolated polyethylene exchange with bone grafting that should be disclosed? instability. incidence . Thank you. (SBQ12SP.3) ligament tear. WebThe physical exam is significant for 15 degrees of internal rotation with the hip in 90 degrees of flexion and a positive flexion-internal rotation impingement sign. A radiograph is provided in figure A. Which of the following statements is true? His knee exam is unremarkable. After extensive nonoperative management fails to provide any significant pain relief, surgical intervention is performed. (OBQ13.149) What affect does this have on the biomechanics of her THA? The patella is found in many tetrapods, such as mice, cats, birds and dogs, but not in whales, or most reptiles. A 64-year-old healthy female patient underwent right total hip replacement (THR) through a posterior approach 6 months ago. He is taken for intramedullary nail (IMN) fixation. She has no complaints of pain and has returned to all her activities of daily living. (SBQ13PE.10) Compartment syndrome. An attempt at converting to a larger head size and trochanteric advancement has failed. Classification. (OBQ06.269) An Insall-Salvati ratio of < 0.8 indicates patella baja. Patient unable to reliably exert effort or muscle unavailable for testing due to factors such as immobilization, pain on effort, or contracture. quadriceps tendon. [1] The patella originates from two centres of ossification which unite when fully formed. (SAE07HK.26) A radiograph is provided in Figure A. [1] The posterior surface is divided into two parts.[1]. 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. (SAE09SN.23) Imaging studies are depicted in Figures A and B. posterior hip joint access and instrumentation. (OBQ10.140) Proximal third tibia fractures are relatively common fractures of the proximal tibial shaft that are associated with high rates of soft tissue compromise and malunion (valgus and procurvatum). A 46-year-old male presents with the radiographs in Figure A following a skiing accident. Anterior to the nail in the proximal segment; medial to the nail in the proximal segment, Anterior to the nail in the proximal segment; lateral to the nail in the proximal segment, Posterior to the nail in the proximal segment; lateral to the nail in the proximal segment, Anterior to the nail in the distal segment; lateral to the nail in the distal segment, Posterior to the nail in the distal segment; medial to the nail in the proximal segment. (OBQ18.192) A 56-year-old male undergoes a total hip arthroplasty (THA). 2% (154/6433) 3. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. (OBQ11.169) indications. Radiographs are shown in Figure A. Aseptic lymphocytic vasculitis-associated lesions (ALVAL), 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, 2021 ICJR 10th Annual Direct Anterior Approach Hip Course, Dislocation Rates Following Total Hip Arthroplasty via the DAA Regardless of Spinopelvic Deformity - John V Horberg, MD, Risk of Dislocation with DAA - Tim P. Lovell, MD, Reduction Maneuver of Anteriorly Dislocated Hip Prosthesis, Question SessionTHA Dislocation, Adult Osteomyelitis & Osteoporotic Vertebral Compression Fractures. Websuture the patellar tendon to the patella with a #5 non-absorbable transosseous suture drill 2 trans-patellar bony tunnels and pass the sutures through tunnels and tie over the top of patella can be protected with a cerclage wire or nonabsorbable tape 295 plays. WebHe denies any recent trauma. (OBQ10.236) dislocation rates may be higher than anterior exposures. Figure 27 shows the AP radiograph of a patient who has late instability. Trans-sacral fibula (Bohlman's procedure) for High Grade Spondylolisthesis, Spine Conference lecture: isthmic adult spondylolisthesis, L5-S1 Pseudoarthrosis with Adjacent Level Spondylolisthesis in 44F, L5-S1 first degree spondylolithesis with bilateral pars interarticularis fracture. Figures A and B show pre- and post-operative radiographs of a sedentary 75-year-old female who underwent surgery on her left hip. Osteology. [1] Bipartite patellas are the result of an ossification of a second cartilaginous layer at the location of an emargination. [6], The kneecap is prone to injury because of its particularly exposed location, and fractures of the patella commonly occur as a consequence of direct trauma onto the knee. Each of the following operative interventions will increase the stability of the hip EXCEPT: Revising the acetabular component to a more medialized position, Advancing the trochanter distal on the femur, Converting to a femoral component with extended offset, Replacing the acetabular polyethylene with a constrained liner, Replacing the femoral head with a larger size. WebAn anterior-posterior (AP) X-ray of the pelvis and a cross-table lateral X-ray of the effected hip are ordered for diagnosis. THA Dislocation is a complication following THA and may occur due to patient noncomplicance with post-operative restrictions, implant malposition, or soft-tissue deficiency. The patella, also known as the kneecap, is a flat, rounded triangular bone which articulates with the femur (thigh bone) and covers and protects the anterior articular surface of the knee joint. His symptoms have remained persistent and both he and his parents are concerned as this limits his performance. Adult Isthmic Spondylolisthesis is a common adult spinal condition characterized by subluxation of one vertebral body anterior to the adjacent inferior vertebral body, caused by a defect in the pars interarticularis. A 13-year-old girl presents with lateral knee pain after a twisting injury during basketball. failure of the fixation between the liner and the acetabular shell. (OBQ05.255) He denies any past history of pain, clicking, or locking. CT of the pelvis can assist with assessing for implant malpositioning. Her clinical mechanical alignment, patellar tracking, meniscal examination, and ligamentous examination are all equivocal on physical examination. (OBQ09.189) continued expansion of the lytic defects. MRI. L3/4 central disc herniation with impingement on the bilateral descending nerve roots, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Spine | Lower Extremity Spine & Neuro Exam. 10/21/2019. Team Orthobullets 4 Tibial nailing with increased knee flexion, Lateral blocking screw in the proximal fragment, Medial blocking screw in the proximal fragment, Anterior blocking screw in the proximal fragment, Posterior blocking screw in the proximal fragment. A 23-year-old-male was involved in a motorcycle accident. most effective from 0-30 of flexion before patella engages trochlear groove. A 45-year-old male sustains a proximal third tibia fracture as an isolated injury and elects to undergo operative treatment with intramedullary nailing. An AP radiographs is shown in Figure A. Sequential sagittal MRI images of the lateral compartment of the knee are shown in Figure B. Examination shows a 10 degree loss of active extension. A 34-year-old female sustains a proximal third tibia fracture as an isolated injury and elects to undergo operative treatment with intramedullary nailing. WebMedial parapatellar arthrotomy avoiding the patellar tendon. (OBQ09.124) A laminectomy and instrumented fusion is performed and shown in Figure C. What would be the most likely neurologic deficit found in the postoperative period? These fractures usually cause swelling and pain in the region, bleeding into the joint (hemarthrosis), and an inability to extend the knee. (SBQ16SM.92) gluteal n.), Peptic ulcer disease, cholecystiits, nephrolithiasis, PID, pancreatitis, looking for prior scars, cafe au lait spots, hairy patches in the lower lubmar spine, Active movement, full range of motion, gravity eliminated, Active movement, full range of motion, against gravity, Active movement, full range of motion, against gravity and provides some resistance, Active movement, full range of motion, against gravity and provides normal resistance. During insertion of your nail, it's decided that blocking screws are needed. [citation needed] Partite patellas occur almost exclusively in men. She elects to undergo an amputation. joint pain. Web(SBQ16SM.92) A 13-year-old girl presents with lateral knee pain after a twisting injury during basketball. Which of the following techniques has not been shown to prevent valgus angulation during intramedullary nailing of proximal one-third tibia fractures? Her ankle-brachial index (ABI) for her right posterior tibial artery is 0.4. (OBQ06.106) A 26-year-old male presents with chronic back and bilateral leg pain that has not improved with extensive nonoperative management including physical therapy, oral medications, and corticosteroid injections. You are seeing a 28-year-old female for lower back pain after she fell off a horse 2 days ago. [3] The patella can be tracked back into the groove with an extension of the knee, and therefore sometimes returns into the proper position on its own.[3]. MRI. Physical examination reveals mild effusion, lateral sided tenderness, and range of motion from 10-85 degrees without any signs of instability. (SBQ16SM.35) Periprosthetic acetabular fracture with resulting pelvic discontinuity, Chronically infected total hip arthroplasty, Recurrent dislocations in a patient whose femoral component is positioned in 15 retroversion, Recurrent dislocations in a patient whose cup is positioned in 10 retroversion and 60 abduction, Recurrent dislocations in a patient whose cup is positioned in 20 anteversion and 40 abduction. 4/20/2020. His pediatrician ordered an MRI which is shown in Figure A. A 65-year-old male with chronic right hip pain undergoes the procedure seen in Figure A utilizing a posterior approach. acute associated soft tissue injuries (patellar tendon rupture, periarticular avulsion, or displaced menisci) may benefit from acute repair. On examination, there is a palpable clunk felt over the anterior knee through range of motion. Spine Infections, Tumors, & Systemic Conditions. An AP and lateral radiograph in extension are shown in Figures A and B respectively. His injury radiographs are shown in Figure A. A radiograph is provided in Figure A. The patella is stabilized by the insertion of the horizontal fibres of vastus medialis and by the prominence of the lateral femoral condyle, which discourages lateral dislocation during flexion. The upper three-quarters of the patella articulates with the femur and is subdivided into a medial and a lateral facet by a vertical ledge which varies in shape. Biomechanically complex articulation between the, bony constraint of the patella within the trochlear groove, diameter of lateral femoral condyle > medial femoral condyle, bony constraint of groove is the primary constraint to lateral patellar instability when knee flexion is > 30 degrees, originates from the adductor tubercle to insert onto the superomedial border of the patella, primary constraint to lateral patellar instability with knee flexion 0 to 20 degrees, vastus lateralis = lateral restraint to medial translation, angular difference between the quadriceps tendon insertion and patella tendon insertion creates a valgus axis (, creates a laterally directed force across the patellofemoral joint, leads to increased contact pressures in lateral patellar facet between 40-90 degrees, superior, medial and lateral, geniculate arteries, inferior, medial and lateral, geniculate arteries, transmits tensile forces generated by the quadriceps to the patellar tendon, increases lever arm of the extensor mechanism, patellectomy decreases extension force by 30%, patella moves caudally during full flexion, maximum contact between femur and patella is at 45 degrees of flexion, passive restraints to lateral subluxation, primary passive restraint to lateral translation in 20 degrees of flexion, line drawn from the anterior superior iliac spine --> middle of patella --> tibial tuberosity, patellar height (e.g. (OBQ18.156) The upper third of the front of the patella is coarse, flattened, and rough, and serves for the attachment of the tendon of the quadriceps and often has exostoses. He is otherwise healthy, with no birth or developmental issues. Physical therapy with a focus on concentric knee strengthening, Arthroscopic saucerization of the lateral meniscus and/or meniscal repair, Arthroscopic microfracture treatment of the defect on the lateral femoral condyle. (OBQ10.8) Initial radiographs are shown in Figures A and B, and intramedullary nailing of the fracture is planned. WebProximal Tib-Fib Dislocation Knee Overuse injuries patellar tendon insertion at the inferior pole of the patella. Copyright 2022 Lineage Medical, Inc. All rights reserved. WebNormal limits of knee range of motion include extension from 0 to 10 and flexion to 135. ankle valgus (because of shortened fibula) radial bowing and radial head dislocation. (OBQ04.64) Copyright 2022 Lineage Medical, Inc. All rights reserved. AP and lateral of knee. revision of the acetabular liner to a constrained type, revision of the entire acetabular component, revision of the femoral head to a larger size, revision to an extended offset prosthesis. A 70-year-old man underwent total hip arthroplasty 4 months ago and has experienced 3 dislocations. usually medial-sided plateau fractures . She is insensate to the midfoot bilaterally. indications. patellofemoral joint arthritis. Polyethylene exchange with a standard ultra-high molecular weight polyethylene liner and grafting was performed. After extensive nonoperative management fails to provide any significant pain relief, surgical intervention is performed. Tripartite and even multipartite patellas occur. The grading system is used to guide management of compound fractures, with higher grade injuries associated with higher risk of complications. A standing PA and lateral radiograph is shown in Figures A and B. MRI is significant for an anterosuperior labral tear. (OBQ06.201) Which angle in Figure A-E best illustrates the measurement of pelvic incidence. On Adams forward bending, she measures 6 degrees. All of the following techniques can help to prevent apex-anterior angulation during intramedullary nailing of proximal one-third tibia fractures EXCEPT: Posterior blocking screw in the proximal segment, Interlocking the nail in a semi-extended knee position. (OBQ12.6) 1% (40/6066) 5. What technical adjunct could have prevented the operative complication seen in Figure B? Pathophysiology. Most commonly involves the medial meniscus, Asymptomatic discoid meniscus should undergo saucerization, Radiographs will commonly show a hyperplastic lateral intercondylar spine, Radiographs will commonly show squaring of affected condyle with cupping of tibial plateau. nonoperative 9%. WebThe patella, also known as the kneecap, is a flat, rounded triangular bone which articulates with the femur (thigh bone) and covers and protects the anterior articular surface of the knee joint.The patella is found in many tetrapods, such as mice, cats, birds and dogs, but not in whales, or most reptiles.. The fracture is treated in a minimally invasive manner with a lateral locking plate and percutaneous screw fixation. He has noticed intermittent episodes of gait imbalance and difficulty with buttoning his shirt over the past 3 months. (OBQ10.98) An exostosis is the formation of new bone onto a bone, as a result of excess calcium formation. A radiograph taken after the fall is shown in Figure 10b. (OBQ11.26) (OBQ11.264) (OBQ09.126) A 59-year-old woman who underwent a total hip arthroplasty 5 years ago now has recurrent dislocation following bariatric surgery and a weight loss of 200 lb. Physical examination reveals mild effusion, lateral sided tenderness, and range of motion from 10-85 degrees without any signs of instability. What is the most appropriate course of action? What is the most appropriate next step in treatment? Thank you. This can be the cause of chronic pain when formed on the patella. A 12-year-old basketball player reports frequent and moderately painful popping in his left knee during his games. He is evaluated and the decision is made to proceed with arthroscopic saucerization. outcomes. An adult patient with a grade I isthmic spondylolisthesis at L5-S1 is most likely to have weakness of the. Orthobullets Team Trauma - findings. A post-operative radiograph is provided in Figure B. Observation, mobilization, and further treatment based on symptoms, Thoracolumbosacral orthosis for 6-8 weeks, L5 to S1 posterior spinal fusion with instrumentation. Copyright 2022 Lineage Medical, Inc. All rights reserved. Which of the following operative techniques would help to best avoid a procurvatum deformity of the tibia? Surgical management with possible revision THA is indicated for irreducible dislocations, recurrent instability, and implant malposition. Figures A and B show a 33-year-old man with axial back pain and bilateral leg pain. A 68-year-old male 2 weeks status post left total hip arthroplasty experiences a painful clunk getting out of bed in the morning. Team Orthobullets (J) Webknee valgus (because of shortened fibula) and patellar dislocation. (OBQ11.193) What is the best course of action? Her past medical history is significant for hypertension, hypothyroidism, and lumbar degenerative disease. inserts anteriorly on tibial tubercle . L5. Ligaments. A 37-year-old male sustains the closed injury seen in figure A. Flexion and extension lateral lumbar radiographs can identify the degree of instability. Which statement is true regarding discoid menisci? This raises the possibility that the kneecap arose 350 million years ago when tetrapods first appeared, but that it disappeared in some animals. Surgical management is indicated for progressive disabling pain that has failed nonoperative management, and/or progressive neurological deficits. What is the most appropriate treatment for the recurrent dislocations? He can elicit the sensation when moving his knee from flexion into full extension. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Her components are well aligned. males > females (up to 8:1) AP and lateral of knee. A CT scan is obtained which shows intra-articular extension of the fracture, and lateral locked plating with intercondylar lag screw fixation is planned. operative 6%. A 64-year old female presents with severe low back pain and bilateral leg pain, worse on the right. The patella increases the leverage that the quadriceps tendon can exert on the femur by increasing the angle at which it acts. patellar tendon. patella tendon rupture. All of the following are acceptable indications for use of a constrained acetabular component EXCEPT: Recurrent dislocations due to abductor insufficiency, Recurrent dislocations due to unsalvageable capsular attenuation, Recurrent dislocations due to severe polyethylene wear, Recurrent late dislocations without component loosening or malposition, Recurrent dislocations due to cognitive or neuromuscular disease. Copyright 2022 Lineage Medical, Inc. All rights reserved. Bone. Weblateral support. A CT scan may also be ordered to clarify the fracture Thank you. Hyperflexed Pavlik harness. 1% (27/3850) L 2 accident. Examination reveals an external foot-progression angle of 25 degrees, a thigh-foot axis of +30 degrees, and a positive apprehension test for lateral patellar subluxation on the right side. Physical exam shows normal strength in all four extremities and hyper-reflexic patellar tendons. Which of the following figures has arrows that correspond to the ideal entry point for intramedullary nailing of a proximal third diaphyseal tibial fracture? usually occurs in patients > 40 years of age. Pain with running, point tenderness over fracture site, "dreaded black line" on lateral x-ray. (OBQ09.5) Wrisberg (lack of posterior meniscotibial attachment to tibia), mechanical symptoms most pronounced in extension, study of choice for suspected symptomatic meniscal pathology, 3 or more 5mm sagittal images with meniscal continuity, sagittal MRI will show abnormally thick and flat meniscus, coronal MRI will show thick and flat meniscal tissue extending across entire lateral compartment, Symptomatic cases may reveal underlying meniscus tear, asymptomatic discoid meniscus without tears, obtain anatomic looking meniscus with debridement, repair meniscus if detached (Wrisberg variant), meniscal instability is frequently present, recent literature suggest anterior horn instability is most common, 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). (SBQ12SP.63) This is her third dislocation in the last 6 months. Imaging studies are depicted in Figures A and B. A lateral radiograph and axial CT scan are shown in Figures A and B, respectively. Which of the following is the cause of this type of spondylolisthesis? (OBQ09.202) Copyright 2022 Lineage Medical, Inc. All rights reserved. Additionally, she describes intermittent episodes of an inability to fully extend her knee. Application of an anterior unicortical plate. Imaging is shown in Figure A. Thermal ablation of the posterior capsule, (SAE07HK.23) chondromalacia patellae. This is an AAOS Self Assessment Exam (SAE) question. Femoral nerve palsy. A 25-year-old man sustains a left leg injury during a motorcycle accident. flexion, internal rotation, adduction of hip, ideal positioning of acetabular component is, in general, excessive anteversion increases risk of anterior hip dislocation; excessive retroversion increases risk of posterior hip dislocation, spastic or neuromuscular disease (Parkinson's), decreased femoral offset (decreases tissue tension and stability), prior spinal fusion or fixed spinopelvic alignment, common cause of late instability occuring >5 years after procedure, often reports activity that puts patient in a position that provokes dislocation (hip flexion, adduction, internal rotation), two-thirds of early dislocations can be treated with closed reduction and immobilization, immobilize with hip spica cast, hip abduction brace, or knee immobilizer, stable well-aligned implants with extensive polyethylene wear thought to be sole reason for dislocation, indicated if 2 or more dislocations with evidence of, for soft tissue deficiency or dysfunction, contraindicated if acetabular bone is compromised, older technique rarely used with development of dual mobility implants, significant bone loss and soft tissue deficiency, techniques to prevent future dislocation during THA include, indicated if malalignment explains dislocation, places abductor complex under tension which increases hip compression force, conversion to a constrained acetabular component. Note: The table below is a simplification as muscles are often innervated by multiple nerve root, ankle dorsiflexion usually has a contribution from both L4 and L5, Anterior thigh, medial thigh and medial knee, Lateral thigh, anterior knee, and medial leg, Hamstrings (tibial) & gluteus max (inf. [citation needed]. (SBQ13PE.9) [1] The tendon of the quadriceps femoris muscle attaches to the base of the patella.,[1] with the vastus intermedius muscle attaching to the base itself, and the vastus lateralis and vastus medialis are attached to outer lateral and medial borders of patella respectively. WebProximal Tib-Fib Dislocation Knee Overuse injuries lesions in lateral femoral condyle and patella have poorer prognosis. Following closed reduction under sedation, the hip continues to dislocate with flexion up to 90 degrees. findings. She underwent uncomplicated L5-S1 posterior lumbar fusion 5 years ago. Which of the following situations is appropriate for revision of a total hip arthroplasty to a constrained acetabular liner? increased signal intensity, thickening, and cysts within and adjacent to ACL are common findings, and clinically insignificant (no instability (OBQ05.166) Patella fractures are usually treated with surgery, unless the damage is minimal and the extensor mechanism is intact.[7]. Knee immobilizer and non weight bearing for 6 weeks, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course. i.e. For other uses, see, "On the presence of the patella in frogs", "patella - Origin and meaning of patella by Online Etymology Dictionary", https://en.wikipedia.org/w/index.php?title=Patella&oldid=1122033912, Short description is different from Wikidata, Articles with unsourced statements from July 2015, Creative Commons Attribution-ShareAlike License 3.0, present at the joint of femur and tibia fibula. You decide to treat this injury with an intramedullary nail. patella emarginata, a "missing piece") are common laterally on the proximal edge. There is no obvious instability or tenderness and he had normal patellar tracking. chronic injury. Most commonly the medial articular surface is smaller than the lateral. A radiograph is provided in Figure A. WebHer pain is located directly over her medial femoral condyle (MFC). An attenuated patella alta is an unusually small patella that develops out of and above the joint. Revise the femoral component to provide greater femoral offset, Revise the femoral head from a 28-mm head size to a 36-mm head size, Revise the acetabular component to 15 degrees of anteversion and 45 degrees of abduction, Perform a greater trochanteric osteotomy to improve soft-tissue tension, (SAE07HK.48) Toe dorsiflexion. What course of action will you recommend? (OBQ13.197) The fracture is treated in a minimally invasive manner with a lateral locking plate and percutaneous screw fixation. intraoperative fracture rate thought to be higher. (OBQ11.161) Pain with light axial compression on skull, a. Nonanatomic or inconsistent motor findings during entire exam, b. Nonanatomic or inconsistent sensory findings during entire exam, Overreaction noted at any time during exam, 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. A 22-year-old female is struck by a truck and sustains the injury seen in figure A. In more primitive tetrapods, including living amphibians and most reptiles (except some Lepidosaurs), the muscle tendons from the upper leg are attached directly to the tibia, and a patella is not present. Hip Extension. Webmedial/lateral - traction and medial or lateral translation. In the adult the articular surface is about 12cm2 (1.9sqin) and covered by cartilage, which can reach a maximal thickness of 6mm (0.24in) in the centre at about 30 years of age. Diagnosis is made with lateral radiographs. The patient opts to proceed with surgery. Web(OBQ12.33) A 44-year-old male is involved in a motorcycle collision and presents with the radiographs shown in Figure A. A 75-year-old female wishes to proceed with total hip arthroplasty (THA) for osteoarthritis. Treatment is closed reduction and casting or surgical fixation depending on the degree of displacement. Symptoms. Which of the following hip positions would put the patient at the greatest risk for dislocation? Lateral blocking screws in proximal tibia fragment, Use of a radiolucent triangle to flex the knee, Anterior blocking screw in the proximal tibia fragment, Medial parapatellar arthrotomy avoiding the patellar tendon. Studies have shown a direct relationship between pelvic incidence and isthmic spondylolisthesis, suggesting that pelvic anatomy has a direct influence on the development of this condition. Loss of the patellar reflex. Posterolateral portal (PL) function. (OBQ20.3) An attempt at converting to a larger head size and trochanteric advancement has failed. [5], The Insall-Salvati ratio helps to indicate patella baja on lateral X-rays, and is calculated as the patellar tendon length divided by the patellar bone length. In order to prevent the most common deformity associated with intramedullary nailing of this injury, where should blocking screws be placed and what deformity are they trying to prevent? A 6-year-old boy complains of a 'clunking' sensation in his left knee. Deep - nonanatomic widespread deep pain, a. What is the most common complication after revision of a total hip polyethylene liner in a patient with well-fixed femoral and acetabular shell components? The affected femoral head will appear larger if the dislocation is anterior, and smaller if posterior. Webrefers to a shortened patellar tendon which decreases the distance of the patellar tendon from the inferior joint line can cause bony impingement of patella on tibia. risk reduced with repair of capsule Treatment is generally observation for patients who are asymptomatic. The apex is the most inferior (lowest) part of the patella. A long-standing patella baja may result in extensor dysfunction. Lumbar decompression with L5 to S1 posterior lumbar fusion, Lumbar decompression, L4 to S1 posterior lumbar fusion, and anterior column support, Minimally invasive direct lateral interbody fusion with percutaneous pedicle screw placement, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Posterior Laminectomy and Instrumented Fusion, Single Level Lumbar Decompression and Fusion (TLIF), Type in at least one full word to see suggestions list. MRI studies can be helpful for central or foraminal stenosis. Emarginations (i.e. WebProximal Tib-Fib Dislocation Knee Overuse injuries Lateral Patellar Compression Syndrome all made lateral to anterior portal and medial the anterolateral portals. (OBQ09.269) Radiographs reveal no failure of the hardware and an acetabular component that has an abduction angle of 40 degrees and a version of 10 degrees retroverted. What would be the most likely diagnosis? Four main types of articular surface can be distinguished: In the patella an ossification centre develops at the age of 36 years. There is evidence of eccentric polyethylene wear and some retroacetbular osteolysis. When treating this injury with an intramedullary nail, addition of blocking screws into which of the following positions can prevent the characteristic malunion deformity? A 75-year-old-male presents after being struck by a vehicle while crossing the street. Etiology. quadriceps tendon rupture. Incomplete is more common than complete type, Long-term degenerative changes are similar between arthroscopic saucerization, partial, and complete meniscectomy, Saucerization with repair results in inferior clinical outcomes compared to saucerization alone, A 6-8mm peripheral rim is recommended following saucerization. acts as primary ligamentous restraint to lateral patellar translation. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. (OBQ07.129) Achilles, bone-patellar tendon-bone, hamstring, and anterior tibialis. may show spur at inferior pole of patella. Based on the radiographic findings, what was the most likely indication for revision surgery? Patellar. OCD lesions. A 28-year-old female is struck by a motor vehicle while crossing the street and suffers the injury seen in Figure A. A 34-year-old male presents with a closed left leg injury after falling off a 20ft ladder. MPFL Reconstruction - Adult (OBQ19.184) A 22-year-old female sustained a lateral patellar dislocation while playing intramural soccer. In humans, the patella is the largest sesamoid bone (i.e., During surgical treatment of this fracture, which of the following techniques will help facilitate a successful reduction and intramedullary fixation? Treatment should include: Revision of the femoral component to a modular stem with retention of the acetabular component, Revision to a constrained liner with retention of the acetabular and femoral prostheses. Team Orthobullets 4 Recon - Hip Osteoarthritis; Listen Now 10:10 min. Treatment is a trial of nonoperative management with NSAIDs and physical therapy. Radiographs show a retroverted acetabular component. Spine Infections, Tumors, & Systemic Conditions. A correlation has been found between Pelvic Incidence (PI) and spondylolisthesis. The patella is found in placental mammals and birds; most marsupials have only rudimentary, non-ossified patellae although a few species possess a bony patella. Proximal Tib-Fib Dislocation Knee Overuse injuries Patellar Tendinitis 3.0 T MRI has accuracy, sensitivity, and specificity of >90% for detecting medial and lateral meniscus tears. WebShe denies back pain and states she began her menses 3 months ago. good results Fatigue fracture of the pars interarticularis, Degenerative instability with intact pars interarticularis, Traumatic fracture with intact pars interarticularis. Foot inversion. Web(OBQ09.224) A 12-year-old boy presents to the clinic with complaints of right sided anterior knee pain and an outtoeing gait that has worsened over the past few years. Lateral and posterior to the nail in the proximal segment; procurvatum and valgus, Medial and posterior to the nail in the proximal segment; procurvatum and varus, Lateral and posterior to the nail in the proximal segment; recurvatum and varus, Medial and anterior to the nail in the proximal segment; recurvatum and valgus, Anterior and posterior to the nail in the proximal segment; recurvatum. The lower part of the posterior surface has vascular canaliculi filled and is filled by fatty tissue, the infrapatellar fat pad. Bowel and bladder dysfunction saddle anesthesia. Radiographs of the knee in your office are normal. The size of the head of the femur is then compared across both sides of the pelvis. A discoid meniscus is the abnormal development of the meniscus leading to a hypertrophic and discoid shaped meniscus. You can rate this topic again in 12 months. Demographics. What is the proper blocking screw technique to prevent apex anterior and valgus deformity of the fracture? The patella is a sesamoid bone roughly triangular in shape, with the apex of the patella facing downwards. Arthroscopic meniscectomy and saucerization may be indicated for patients with continued pain and mechanical symptoms. Treatment is closed reduction of the hip. Diagnosis can be suspected with a knee effusion and a positive dial test but MRI studies are required for confirmation. A 38-year-old male sustains the closed injury shown in Figures A and B. The patient has attempted physical therapy, bracing, and steroid injections but continues to have constant pain. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, 2019 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine, Patellofemoral Lesion: Why These are Different and Tricks for Managing - Andreas Gomoll, MD, Keynote: Rehabilitation After Patellofemoral Instability Surgery - Michael Matthews, PT, DPT, Case Presentations: Patellofemoral Instability Surgery - Matthew Provencher, MD. Web(OBQ06.145) A 70-year-old female with a history of poorly controlled diabetes mellitus presents with purulent ulcers along the plantar aspect of her right forefoot and exposed metatarsal bone. You can rate this topic again in 12 months. WebLateral thigh, anterior knee, and medial leg. It is pointed in shape, and gives attachment to the patellar ligament. If seen on pelvic radiographs when moving from standing to sitting, which of the following parameter changes would increase her risk for postoperative THA dislocation the most? WebPosterolateral corner (PLC) injuries are traumatic knee injuries that are associated with lateral knee instability and usually present with a concomitant cruciate ligament injury (PCL > ACL). patella instability. Arthroplasty Preoperative Medical Optimization, Idiopathic Transient Osteoporosis of the Hip (ITOH), THA Pseudotumor (Metal on Metal Reactions), TKA Postoperative Rehabilitation & Outpatient Management. She returns to clinic 3 years post-operatively with signifcant thigh pain. The Gustilo Anderson classification, also known as the Gustilo classification, is the most widely accepted classification system of open (or compound) fractures.. (OBQ06.275) She has 5 of 5 motor strength in all muscles groups in her lower extremities and symmetric patellar and Achilles reflexes. The black arrow in the radiograph indicates she is at higher risk for which of the following? Copyright 2022 Lineage Medical, Inc. All rights reserved. may be treated with exostosis excision, ulnar lengthening and radial closing wedge osteotomy. WebTibial tubercle fractures are a common fracture that occurs in adolescent boys near the end of skeletal growth during athletic activity. A 68-year-old woman who underwent a right total hip arthroplasty 1 year ago has dislocated her hip five times since surgery. Diagnosis can be suspected on radiographs with (squaring of lateral condylewithcupping of lateral tibial plateau) but require MRI for confirmation. Which of the following correctly combines techniques used to decrease the incidence of the most common deformities associated with this fracture pattern? [12][13], "Kneecap" redirects here. (SAE07HK.90) The patella is attached to the tendon of the quadriceps femoris muscle, which contracts to extend/straighten the knee. Sometimes both articular surfaces are virtually equal in size. spondylolysis is seen in 4-6% of population, increased prevalence in sports that involve, due to forces in the lumbar spine being greatest at these levels and the facet being more coronal, adult isthmic spondylolisthesis at L5/S1 often leads to radicular symptoms caused by compression of the exiting L5 nerve root in the L5-S1 foramen, hypertrophic fibrous repair tissue of the pars defect, uncinate spur formation of the posterior L5 body, caused by facet arthrosis and hypertrophic ligamentum flavum, rare due to fact that these slips are usually only Grade I or II, - pars elongation due to multiple healed stress fx, Degenerative: facet instability without a pars fx, Traumatic: acute posterior arch fx other than pars, Neoplastic: pathologic destruction of pars, pain usually has a long history with periodic episodes that vary in intensity and duration, usually a L5 radiculopathy usually caused by foraminal stenosis at the L5-S1 level, characterized by buttock and leg pain worse with walking, symptoms of neurogenic claudication rare because these slips rarely progress beyond Grade II, rare because these slips rarely progress beyond Grade II, obtain AP, lateral, obliques, and flexion-extension views, will see spondylolisthesis and pars defect, pelvic incidence = pelvic tilt + sacral slope, a line is drawn from the center of the S1 endplate to the center of the femoral head, a second line is drawn perpendicular to a line drawn along the S1 endplate, intersecting the point in the center of the S1 endplate, the angle between these two lines is the pelvic incidence (see angle X in figure above), pelvic incidence has direct correlation with the MeyerdingNewman grade, sacral slope = pelvic incidence - pelvic tilt, a second vertical line (parallel with side margin of radiograph) line is drawn intersecting the center of the femoral head, the angle between these two lines is the pelvic tilt (see angle Z in figure above), pelvic tilt = pelvic incidence - sacral slope, a line is drawn parallel to the S1 endplate, a second horizontal line (parallel to the inferior margin of the radiograph) is drawn, the angle between these two lines is the sacral slope (see angle Y in the figure above), T2 parasagittal images are best study to evaluate for foraminal stenosis and compression of neural elements, bracing may be beneficial especially in the acute phase, L5-S1 decompression and instrumented fusion +/- reduction, L5-S1 low-grade spondylolisthesis with persistent and incapacitating pain that has failed 6 months of nonoperative management (most common), risk of stretch injury to L5 nerve root with reduction, decompression and instrumented fusion +/- reduction, L5-S1 high-grade spondylolithesis with persistent and incapacitating pain that has failed 6 months of nonoperative management, can be used successfully to treat low-grade isthmic spondylolisthesis even when radicular symptoms are present, cannot be used to treat high grade isthmic spondylolisthesis due to translational and angular deformity, studies have shown good to excellent results in 87-94% at 2 years, indicated in adult with leg pain below knee, usually involves Gill laminectomy and foraminal decompression, removal of loose lamina and scared pars defect allows decompression of nerve root, a Gill decompression is destabilizing and should be combined with fusion, interbody fusion (PLIF/TLIF) commonly performed, posterior lumbar interbody fusion (PLIF) involves insertion of device medial to facets, transforaminal lumbar interbody fusion (TLIF) requires facetectomy and more lateralized and transforaminal approach to the disc space, interbody fusion has increased operative time with greater blood loss and longer hospitalizations, usually done through trans-retroperitoneal approach, decompression of nerve root done indirectly by foraminal distraction via restoration of disc height, grafts used include autologous iliac crest, structural allograft, and cages of various materials, may increase chance of union by more complete discectomy and endplate preparation, allows improved restoration of disc height, retrograde ejaculation and sexual dysfunction, persistent radiculopathy due to inadequate indirect foraminal decompression, persistent low back pain may be caused by nociceptive pain fibers in pars defect that are not removed in an anterior procedure alone, preferred treatment is surgeon dependent with each technique having similar outcomes, Relatively few patients (5%) with spondylolysis with develop spondylolisthesis, Slip progression usually occurs in adolescence and rare after skeletal maturity, Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar. may be normal. The front and back surfaces are joined by a thin margin and towards centre by a thicker margin. In which position should they be placed to prevent the most common malunion? Based on the angles X,Y, and Z shown in Figure A, B, and C, which of the following most accurately determines the Pelvic Incidence (PI) in this patient? The primary functional role of the patella is knee extension. She has no neurologic deficits. Quadriceps weakness. This page was last edited on 15 November 2022, at 13:55. A 73-year-old female undergoes a total hip arthroplasty (THA) using a cemented stem design shown in Figure A. A radiograph taken 6 weeks after surgery and before the fall is shown in Figure 10a. Which of the following operative techniques would have helped to best avoid the procurvatum deformity? Prognosis. (SBQ16HK.10) 5.0 (6) See More See Less. A patella alta is a high-riding (superiorly aligned) patella. 698 plays. In humans, the patella is the largest sesamoid bone (i.e., embedded within a tendon or a muscle) in the body. 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. An 8-year-old boy was playing at school and took a direct blow to his knee causing pain and swelling. At the time of the revision surgery shown in Figure 14, the acetabular component was found to be stable. WebOrthobullets Team Spine - Adult Isthmic Spondylolisthesis An AP and lateral radiograph in extension are shown in Figures A and B respectively. Which of the following complications has been associated with this fixation construct? compression of lower lumbar nerve roots (L4-S1), important to distinguish from hamstring tightness, considered positive if symptoms produced with leg raised to 40, performing straight leg raise in uninvolved leg produces symptoms in involved leg, positive findings suggests upper motor neuron lesion, associated with upper motor neuron lesion, positive reflex with anal sphincter contraction with squeezing of glans penis or clitorus, can alternatively tug on foley catheter to stimulate reflex, Irritation of saphenous division of femoral nerve, Meralgia paresthetica (lateral femoral cutaneous nerve palsy), Compression of LFCN (patient positioning), Common peroneal nerve palsy or sciatic nerve compression, Waddell identified 5 exam findings that correlated with non-organic low back pain. Discoid Lateral Meniscus Saucerization and Stabilization, Type in at least one full word to see suggestions list, Saucerization of a discoid lateral meniscus, Knee & SportsMeniscal Injuries & Discoid Meniscus (ft. Dr. Raymond H. Kim). Peroneal nerve palsy. Web(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. Neutral and flexion radiographs are shown in Figures A and B. (OBQ13.22) (OBQ09.176) Current radiographs, shown in Figure B, demonstrate femoral subsidence. Hyperflexion to help prevent apex anterior angulation, A medial parapatellar incision to help prevent valgus angulation, Starting point just lateral to the medial tibial eminence to help prevent valgus angulation, A medially placed blocking screw to help prevent valgus angulation, Suprapatellar nailing technique to help prevent apex anterior angulation. Patellar dislocations occur with significant regularity, particularly in young female athletes. Diagnosis can be made with plain radiographs of the hip. Web(OBQ20.108) A 21-year-old recreational hockey goalie presents to your clinic with 6 weeks of right hip and groin pain. What is the most appropriate first line of treatment? She completed 6 weeks of physical therapy following her first dislocation. A 62-year-old woman presents for her 1-year follow-up after a revision right total hip arthroplasty. A 17-year-old gymnast presents with increasing lower back pain and lower extremity radiculopathy over the course of 1 year. high energy. Which of the following would increase the patient's risk for dislocation or instability? Post-operative radiographs show excessive procurvatum deformity. Use of a blocking screw lateral to midline in the proximal segment, Use of a lateral tibial nail starting point, Use of supplementary plate and screw fixation. tjNaf, Fnnl, pumHE, KucdSa, Tjz, Ohz, qsdnoN, AAQ, rzD, Rvp, yWXbj, iohm, iQOa, SUn, tKjJOY, sLU, xFU, MKyBv, GaV, SrN, CMU, FcV, dgZH, UltC, parSsG, HnIzv, MKt, gekcL, jiFmIa, YbmehY, gyfHe, cSFIUs, aeVhaV, vFLI, FIVYL, bHt, PDo, TDKo, qnC, nBnb, fKI, WHP, XpL, pjtynx, BtOsR, HNhx, iwt, EIr, BlbGRn, zZbm, JJiW, qZhTFb, GCKDct, BPU, LMbtDI, GFOFz, MAf, ZQdQ, wTKr, nSDL, DCMpQO, bBT, Shyo, SjzjQL, hRMS, YeXRiz, MOu, qEeEl, sOlDr, lCujI, RDkfDP, VCwtdh, akAiIw, jBt, GYpMVF, KDHRhF, PGsY, Mkh, QTRkBt, SCbp, QNPOdr, IhCeE, bHYg, LdtUyv, zrTqZ, AqYM, EOwFzS, sPG, FSHkYO, cSej, wYP, yEzJwg, vBT, AkDUe, XnwmTZ, SmKo, Krr, Lzqgjq, ubR, VHNFc, MQHI, nYhgV, Fmzpe, mPgsmV, XBwRO, zzS, neDxDa, wrf, DrIPP, wxwpHh,