1 SURGERY EOR EXAM ELABORATION 2024 VERSION WITH 1000 QUESTIONS AND 100% VERIFIED SOLUTIONS/GRADED A+ Maisonneuve fracture - ANSWER -Proximal fibular fracture with associated distal injury - Can often be missed when original injury is in the ankle Ankle syndesmosis - ANSWER - Interosseous ligaments that firmly attach the distal tibia to the distal fibula - Injury here is a high ankle sprain Mortise view - ANSWER View of ankle in which you rotate the lower leg and ankle 15 -20 degrees internally to get the intermalleolar plane parallel to the coronal plane Most common disorder of the knee? - ANSWER Patellofemoral dysfunction Q angle - ANSWER Angle formed by drawing a line from the center of the patella to the anterior superior iliac spine, and from the tibial tubercle through the center of the patella; men average a 10 -degree angle whereas women average about 15 degrees. Factors increasing Q angle - ANSWER - Flat feet - Genu valgus - Female Presentation of Patellofemoral pain syndrome - ANSWER - Insidious onset of pain - No particular trauma brings about pain 2 - Pain often worsens when ascending/descending stairs, squatting, prolonged sitting. - Grinding behind kneecap with movement A patella typically subluxes in what direction? - ANSWER Laterally Tx of Patellofemoral pain syndrome - ANSWER - Quad strengthening - Stretching - Arch support - NSAIDs - Bracing Tx of Recurrent dislocation and subluxation of patella - ANSWER - Conservative measures at first - Surgical intervention is appropriate if conservative tx fails - Changes support around patella - Distal realignment is last resort MOA of a Patellar/ Quadriceps tendon rupture - ANSWER - Typically occurs with a fall on a partially flexed knee - Pt may be able to ambulate but with a feeling the knee is going to "give way" - Hallmark *INABILITY TO PERFORM A STRAIGHT LEG RAISE* Presentation of a patella ligament rupture - ANSWER -Patella is high riding in a patella ligament tear Stellate fracture - ANSWER - Burst fracture in all directions Bipartite patella - ANSWER patella in which superior lateral angle ossifies independently A tear of the MCL results from what type of force on the knee? - ANSWER Valgus 3 LCL sprain/tear results from a _______ force - ANSWER Varus T/F All MCL tears and minor LCL tears are treated conservatively with Hinged brace, NSAIDs and rehab - ANSWER TRUE T/F complete LCL tears need to be repaired surgically - ANSWER TRUE (Poor blood supply) Half of all pts with an ACL injury also have? - ANSWER A meniscal injury Meniscal injury - ANSWER - May be traumatic or degenerative - Results from a twisting injury - Pain occurs with twisting, squatting or pivoting - Positive McMurray's tst Tx of meniscal tear - ANSWER - Conservative tx at first (PT and intra -articular steroid injection) - Surgical menisectomy may be considered Osgood -Schlatter's disease - ANSWER - Pain and edema at the tibial tubercle - Most often occurs in pre -adolescents who play sports which involve running and jumping - Typically self -limiting Tx of Osgood -Schlatter's disease - ANSWER - Conservative tx is most effective - RICE Tibial plateau fracture - ANSWER This fracture involves the proximal articular surface at the knee of the tibia typically from a fall or significant trauma. 4 - *Beware of compartment syndrome and neurovascular injury* Exertional Compartment syndrome - ANSWER This is an exercise induced pathologic increase in tissue pressure in one or more of the four muscle compartments - Anterior most common - Compression of the vascular structures and nerves lead to loss of blood supply and sensation deficit in distal extremities - *May exhibit dorsiflexion weakness and paresthesias in first webspace* Tx of Exertional compartment syndrome - ANSWER - Reduction of activity to subsymptomatic levels - Fasciotomy if conservative tx fails Plantar fasciitis - ANSWER Inflammation/micro -tearing of the plantar fascia from over use - Presents as plantar foot pain - *First step in morning is most painful* Tx of Plantar fasciitis - ANSWER - Stretching regimen and night splint - Steroid injection - If still refractory immobilization in neutral position for 8 weeks Imaging modality of choice for stress fracture? - ANSWER Bone scan or MRI Traumatic myositis ossificans - ANSWER the formation and deposition of fibrous tissue and bone following a traumatic injury to a muscle - Most commonly seen in quadriceps after a tearing injury - *Mass usually subsides in the absence of reoccurring trauma*
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