Freiberg's Infraction. 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 component (generally considered open reduction and internal fixation. (OBQ05.128) indications. Studies. 12% (235/2011) 3. Restart >14 days postoperatively. Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. 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 component (generally considered MRI of the right foot can be seen in Figure A. Anterior tarsal tunnel syndrome. Cranial migration of the dens from soft tissue erosion and bone loss between occiput and C1&C2, Rupture of flexor pollicis longus in the carpal tunnel, Synovitis in the DRUJ leading to supination of the carpal bones away from the head of the ulna, Rupture of the hand digital extensor tendons, Synovitis of the MTP joints with eventual hyperextension deformity of the MTP. (OBQ18.111) 12% (235/2011) 3. wide shoe box with firm sole and metatarsal pad . Treatment. Second metatarsal base stress fracture. Her radiographs and bone scan are shown in Figures A and B. children < 2-3 years old due to non-accidental trauma, adolescents involved in motor vehicle accidents, can result from low-energy trauma if the patient has weakened bone (i.e. MTPJ arthritis. 5.0 (1) See More See Less. Recalcitrant medial sesamoid stress fracture with fragmentation. 85% (1536/1804) 3. 56% (1135/2011) A 43-year-old female with long-standing rheumatoid arthritis complains of right forefoot pain for several years. The patient has palpable pulses, active drainage at the ulcer, and does not have protective sensation with a 5.07 Semmes-Weinstein filament. 1% (37/3108) 2. The patient notes worsening pain at the toe-off phase of gait. Which of the following is the best dosing recommendation for her antirheumatic medications prior to surgery? A representative coronal MRI sequence at the level of the cuboid is shown in Figure A. Intra-operatively, the peroneal tendon located directly posterior to the fibula is found to be normal. Surgical repair is indicated for patients with progressive and persistent symptoms who fail nonoperative management. Classification. can result in 5th metatarsal stress fractures. MTPJ arthritis. First branch of the lateral plantar nerve (Baxter's) entrapment. Rheumatoid Arthritis is a chronic systemic autoimmune diseasecaused by IgM cell-mediatedimmune response against soft tissues, cartilage, and bone. 1st metatarsophalangeal (MTP) plantar plate reconstruction, 1st metatarsophalangeal (MTP) arthroscopy and debridement, Open reduction internal fixation of sesamoid with autogenous calcaneus bone graft, Distal 1st metatarsal chevron osteotomy with proximal phalanx Akin procedure. 11/11/2019. What changes should be made to her medication regimen prior to surgery? Stress fracture. (OBQ06.111) trauma leading to forced external rotation and abduction of ankle. She presents for her preoperative visit and asks about dosing of her antirheumatic medications. can result in 5th metatarsal stress fractures. TNF antagonists (etanercept, infliximab, adalimumab). Inheritance Patterns of Orthopaedic Syndromes, General and Regional Anesthesia in Orthopaedics, Legal Considerations in Orthopaedic Practice. 2% (109/5473) L 2 5th Metatarsal Base Fracture Metatarsal FX Navicular stress fracture. cast immobilization for 8 weeks. Treatment. 5th Metatarsal Base Fracture Metatarsal FX any navicular stress fracture, regardless of type, can be initially treated with cast immobilization and nonweight bearing for 6-8 weeks with high rates of success. 2% (56/3108) 3. Ankle sprains involve an injury to the ATFL and CFL and are the most common reason for missed athletic participation. Plantar fasciitis. Plantar fascia strain. Treatment. pain over syndesmosis is elicited with external rotation/dorsiflexion of the foot with knee and hip flexed to 90 degrees. What is the most appropriate management? Pain is worsened with passive toe extension. fracture (caused by hyperextension and axial loading), potential avulsion of plantar plate off base of phalanx, sesamoids play important role in function of great toes by, FHB attaches to both tibial and fibular sesamoid, sesamoids are connected to each other by intersesamoid ligament and plantar plate, abductor hallucis is connected to tibial sesamoid, adductor hallucis is connected to fibular sesamoid, sesamoid function is analogous to the patella as they increase the mechanical advantage of the FHB, possible plantar-flexed MTP with cavus foot, helps distinguish a bipartite sesamoid from a fracture, use caution with interpretation as 25%-30% of asymptomatic patients can have increased uptake, increased uptake compared to uninjured side helps diagnosis, keratotic lesion present increasing pressure on sesamoids, nonoperative management fails after 3-12 months, plantar-flexed first ray with sesamoid injury, may be partial or complete sesamoidectomy, removal of both sesamoids is associated with a high incidence of cock-up deformity of the great toe, caused by weakening of the flexor hallucis brevis tendon, which should be meticulously repaired after sesamoid excision, excision of both sesamoids should be avoided, may be caused from tibial sesamoid excision, may be caused by fibular sesamoid excision, Posterior Tibial Tendon Insufficiency (PTTI). Stress fracture. 5th Metatarsal Base Fracture gravity stress view can identify medial clear space widening. Hallux valgus. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Foot & AnkleSesamoid Injuries of the Hallux. 56% (1135/2011) Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. (OBQ11.253) A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. 5% Distal 1st metatarsal chevron osteotomy with proximal phalanx Akin procedure. (OBQ13.151) 89% (3285/3693) L 1 Orthobullets Team Foot & Ankle - Lisfranc Injury; Listen Now 17:18 min. An MRI is performed and selected cuts are shown in Figures B and C. What is this patients diagnosis? A 64-year-old woman with a longstanding history of rheumatoid arthritis complains of finger dysfunction for the past 6 months. 5th Metatarsal Base Fracture gravity stress view can identify medial clear space widening. Second metatarsal base stress fracture. Anterior tarsal tunnel syndrome. This is an AAOS Self Assessment Exam (SAE) question. A 72-year-old female with rheumatoid arthritis is scheduled to undergo total hip arthroplasty. 2% (68/3108) 5. 56% (1135/2011) What is the next most appropriate treatment for the ring finger? 1% (80/5501) 5. A radiograph is shown in Figure B. Diagnosis can be made with plain radiographs of the hip. Neoplasm. She sees a podiatrist for shaving of her plantar forefoot calluses. 2-4 cm in length. Gustilo-Anderson classification. metatarsal stress fracture. Gustilo-Anderson classification. (OBQ10.93) , with progressive hand and wrist deformity. Classification. 1% (80/5501) 5. Hunter syndrome (type II mucopolysaccharidosis), 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Hand Manifestation of Rheumatoid Arthritis - Michael Firtha, DO, Arthrodesis & Arthroplasty of Small Joints of the Hand - Shaan Patel, MD, Cleveland Combined Hand Fellowship Lecture Series 2019-2020, Small Joints Arthroplasty vs Arthrodesis - Imad Abushahin, MD, Basic Science | Rheumatoid Arthritis of the Elbow (ft. Dr. Matthew L. Ramsey), Hip pain with an unusual pelvic XRay in a 68M. normal deltoid ligament. MTPJ arthritis. She currently takes etanercept weekly and hydroxychloroquine daily. Nonoperative. Calcaneonavicular Ligament (Spring Ligament) Function. What is the most important consideration in the preoperative evaluation of a child with polyarticular or systemic juvenile rheumatoid arthritis (JRA)? Which of the following medications when combined with methotrexate has been shown to be more effective than methotrexate alone in the treatment of rheumatoid arthritis? Treatment is nonoperative versus operative based on fracture displacement and alignment, associated soft tissue injury, and patient risk factors. 1% 5% (127/2520) L 2 D Select Answer to see Preferred Response. Nonoperative. The patient has palpable pulses, active drainage at the ulcer, and does not have protective sensation with a 5.07 Semmes-Weinstein filament. combination of force and joint positioning causes attenuation or tearing of the plantar capsular-ligamentous complex, tear to capsular-ligamentous-seasmoid complex, tear occurs off the proximal phalanx, not the metatarsal, cartilaginous injury or loose body in hallux MTP joint, articulation between MT and proximal phalanx, abductor hallucis attaches to medial sesamoid, adductor hallucis attaches to lateral sesamoid, attaches to the transverse head of adductor hallucis, flexor tendon sheath and deep transverse intermetatarsal ligament, mechanism of injury consistent with hyper-extension and axial loading of hallux MTP, inability to hyperextend the joint without significant symptoms, comparison of the sesamoid-to-joint distances, often does not show a dislocation of the great toe MTP joint because it is concentrically located on both radiographs, negative radiograph with persistent pain, swelling, weak toe push-off, hyperdorsiflexion injury with exam findings consistent with a plantar plate rupture, persistent pain, swelling, weak toe push-off, used to rule out stress fracture of the proximal phalanx, nonoperative modalities indicated in most injuries (Grade I-III), taping not indicated in acute phase due to vascular compromise with swelling, stiff-sole shoe or rocker bottom sole to limit motion, more severe injuries may require walker boot or short leg cast for 2-6 weeks, progressive motion once the injury is stable, headless screw or suture repair of sesamoid fracture, joint synovitis or osteochondral defect often requires debridement or cheilectomy, abductor hallucis transfer may be required if plantar plate or flexor tendons cannot be restored, immediate post-operative non-weight bearing, treat with cheilectomy versus arthrodesis, depending on severity, Can be a devastating injury to the professional athlete, Posterior Tibial Tendon Insufficiency (PTTI). 2% (29/1804) 4. Treatment depends on the specific injury to the sesamoid complex, chronicity and patient activity demands. Classification. Galeazzi Fracture - Pediatric stress fractures along the fourth and/or fifth metatarsal bases can develop secondary to repetitive load along the lateral border of the foot. What is the mechanism of action of Infliximab? Infliximab is a medication associated with opportunistic infections in patients with rheumatoid arthritis. Treatment. In the treatment of patients with rheumatoid arthritis, TNF-alpha is blocked by which of the following agents? Turf Toe is a hyperextension injury to the plantar plate and sesamoid complex of the big toe metatarsophalangeal joint that most commonly occurs in contact athletic sports. (OBQ12.224) tumors, metabolic bone disease), 30-85% of patients will have associated traumatic injuries, proximal femur develops from 2 centers of ossification, ossification begins at 4-6 months in girls and 5-7 months in boys, responsible for metaphyseal growth of femoral neck, accounts for 13-15% of overall leg length, ossification begins at 4 years in both girls and boys, responsible for appositional growth of greater trochanter, also makes small contribution to growth of femoral neck and intertrochanteric femur, injury to the GT apophysis leads to shortening of the GT and, via the posterosuperior and posteroinferior retinacular branches, at birth, contributes to the blood supply to the head with the LFCA and artery of ligamentum teres, at 4 years old, becomes the main blood supply, at birth, contributes to the blood supply to the head, also contribute to blood supply to the head < 3 years old and after 14-17 years, between 3 to 14-17 years, the physis blocks metaphyseal supply, after 14-17 years, anastomoses between metaphyseal-epiphyseal vessels develop, Transphyseal (with or without epiphyseal dislocation), bone survey if suspected non-accidental trauma, break/offset of bony trabeculae near Ward triangle, indicates nondisplaced or impacted fracture, nondisplaced fractures and stress fractures, nondisplaced fractures and stress fractures (preferred over CT), well-defined low-signal line and surrounding high-signal bone edema on T2-weighted images, difficult to differentiate from effusion due to inflammation or infection, closed reduction and spica abduction casting, Type I without epiphyseal dislocation, II, III, IV IF nondisplaced/minimally displaced AND < 4 years old, evaluate type I fractures for non-accidental trauma if young (< 2-3 years old), vessel injury where large vessel repair is required (rare), concomitant hip or epiphyseal dislocations (especially type I), some data suggests this may decrease the rate of AVN, type I (without epiphyseal dislocation), II, III if displaced and/or > 4 years old, smooth pins may be adequate in young patients if postoperative spica casting performed, cannulated screws in older patients and adolescents, fracture brace or spica cast if there is concern that the long lever arm of the leg could contribute to loss of fixation of the fracture, type I II, III if unable to achieve closed anatomic reduction, consider fracture brace or spica cast if concern for stability of fracture, early reduction (< 24h) may diminish risk of AVN, fracture table (preferred for most patients), can use radiolucent table for younger patients, apply gentle longitudinal traction with abduction and internal rotation, follow with weekly radiographs for 3 weeks to make sure reduction maintained, < 2mm cortical translation, < 5 of angulation, no malrotation, aspiration with large bore needle through subadductor/anterior hip approach, open capsulotomy through anterior incision, type I without epiphyseal dislocation, II, III in patients, older patients close to skeletal maturity (> 12yrs old), when there is little metaphyseal bone available, where crossing the physis is necessary to achieve stable fixation, it is easier to treat leg length discrepancy from premature physeal closure than nonunion, avoid anterolateral quadrant of epiphysis and posterior perforation of femoral neck, post-op spica casting (abduction and internal rotation) for 6-12 weeks if < 4yrs or pin/screw placement short of the physis, long lever arm of the leg could contribute to loss of fixation of the fracture, risk increases 1.14 times for every year of increasing age, highest risk with type I (transphyseal) fractures, type III - area of necrosis in femoral neck from fracture line to physis, young patients (0-3 yrs) will remodel if neck-shaft angle > 110, surgical arrest of trochanteric apophysis, subtrochanteric or intertrochanteric valgus osteotomy, coxa vara with severe Trendelenburg limp or signs/symptoms of FAI, seen in type IV fractures involving GT in younger patients, can occur together with coxa vara (see above), nonoperative treatment of type II or III fractures, ORIF and immobilization (spica cast if younger patient), proximal femoral physis contributes to 15% of overall limb length (3 mm/yr), significant (> 2cm) leg length discrepancy is rare and only occurs in very young children, penetration of physis by fixation devices, significant LLD occurs in combined AVN and physeal arrest, epiphysiodesis of contralateral distal femur proximal tibia, poor vascularity to femoral head cartilage, presents as restricted hip motion, hip pain, radiographic joint space narrowing, deforming forces lead to proximal fragment in flexion, abduction, and external rotation, Poor functional outcomes have been associated with, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). Ankle sprains involve an injury to the ATFL and CFL and are the most common reason for missed athletic participation. Percutaneous pinning of the physeal fracture and long leg cast placement. Treatment is urgent to avoid complication of osteonecrosis, nonunion, and premature physeal closure. An AP radiograph is shown in FIgure A. He is exquisitely tender over the 1st metatarsal. Patients present with insidious onset ofmorning joint stiffness, polyarthropathy. Copyright 2022 Lineage Medical, Inc. All rights reserved. Cotton. Treatment usually includes a period of immobilization followed by physical therapy. Plantar fasciitis. Stress fracture. (OBQ13.169) Stage 1. Copyright 2022 Lineage Medical, Inc. All rights reserved. Treatment is urgent to avoid complication of osteonecrosis, nonunion, and premature physeal closure. 5% Distal 1st metatarsal chevron osteotomy with proximal phalanx Akin procedure. Coupled with Lapidus procedure for hallux valgus, Recalcitrant medial sesamoid stress fracture with fragmentation, Coupled with first metatarsophalangeal joint arthrodesis for hallux rigidus. Inhibition of dihydrofolate reductase (DHFR), Monoclonal antibody against CD20 on B-cell surface. Treatment is either immobilization or surgery depending on location of fracture, degree of displacement, and athletic level of patient. Second metatarsal base stress fracture. Discontinuation of all three medications 1 weeks prior to surgery, Discontinuation of sulfasalazine 1 weeks prior to surgery, continuation of etanercept and penicillamine, Continuation of sulfasalazine, penicillamine, and etanercept, Continuation of sulfasalazine and penicillamine, discontinuation of etanercept 1 week prior to surgery, Continuation of penicillamine, discontinuation of sulfasalazine and etanercept 1 week prior to surgery. may occur with fracture of the medial malleolus. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, 2019 Orthopaedic Summit Evolving Techniques, He Is Playing With Nonoperative Treatment - Michael Coughlin, MD, He Is Out! rest, NSAIDs, taping, stiff-sole shoe, or walking boot in the majority of cases. Team Orthobullets 4 Foot & Ankle - Turf Toe; Listen Now 12:45 min. may occur with fracture of the medial malleolus. (OBQ10.263) First branch of the lateral plantar nerve (Baxter's) entrapment. Treatment usually includes a period of immobilization followed by physical therapy. Tenosynovectomies with extensor indicis proprius (EIP) to EDQ transfer, Tenosynovectomies with extensor reconstructions (central slip imbrication, Fowler distal tenotomy), Metacarpal joint resection arthroplasties with palmaris autograft interposition, Extensor tendon relocation, extrinsic tendon release, and metacarpophalangeal joint collateral ligament reefing. normal deltoid ligament. Lumbar radiculopathy. leads to eventual collapse of 2nd MT head. Nonoperative. 93 plays. NB: fracture comminution is not considered in the grading system. Calcaneal Lengthening Osteotomy Fifth metatarsal fracture. Ankle sprains involve an injury to the ATFL and CFL and are the most common reason for missed athletic participation. 1% 76% (1926/2520) 4. used to rule out stress fracture of the proximal phalanx. Which of the following surgical options would most reliably return her to sporting activities in a timely fashion? First metatarsal base stress fracture. MRI. Treatment. First metatarsal base stress fracture. A collegiate soccer player presents as a referral to your office after sustaining an injury to the right foot, which he describes as hyperdorsiflexion of the toes. spread the metatarsal bones to visualize the webspace, as well as tension the transverse intermetatarsal ligament. A representative coronal MRI sequence at the level of the cuboid is shown in Figure A. Intra-operatively, the peroneal tendon located directly posterior to the fibula is found to be normal. Diagnosis is suspected with hallux pain that is worse with hyperextension and can be confirmed with MRI studies. Stress fracture. Hallux valgus. 5.0 (1) See More See Less. most common extra-articular manifestation of RA, seen in 25% of patients with RA and associated with, erosion through skin may lead to formation of sinus tract, patients complain of pain and cosmetic concerns, cosmetic concerns, pain relief, diagnostic biopsy, seen in patients with RA or psoriatic arthritis, digits develop gross instability with bone loss (, treated with interposition bone grafting and fusion, volar subluxation associated with ulnar drifting of digits, extrinsic extensor tendons subluxate ulnarly, lax collateral ligaments allow ulnar deviation deformity, ulnar intrinsics contract further worsening the deformity, thumb MCP involvement + thumb IP involvment, important to correct wrist deformity at same time if it is radially deviated, synovectomy, volar capsular resection, ulnar collateral ligament release, radial collateral ligament repair/reconstruction, extensor tendon realignment, intrinsic tendon release, 1 year followup shows improved ulnar drift and extensor lag, thumb MCP involvement without IP involvement, FDS, volar plate and collateral ligament attenuation, contracture of triangular ligament, attenuation of, for flexible PIP (prevent hyperextension), Nalebuff Classification of Rheumatoid Thumb Deformities, Stage 1: Synovectomy with extensor hood reconstruction, Stage 3: IP and MCP fusion (if CMC is normal). 1% (37/3108) 2. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. 1% (80/5501) 5. Operative. indications. Immunological testing of anti-cyclic citrullinated peptide antibodies (anti-CCP) is most commonly used for the diagnosis and prognosis of which immunological condition? 85% (1536/1804) 3. Which of the following medications specifically target tumor necrosis factor alpha (TNF-a)? may occur with fracture of the medial malleolus. Treatment may be casting or operative depending on the age of the patient and the type of fracture. Nonoperative. 5th Metatarsal Base Fracture Metatarsal FX Tarsal Navicular FX external rotation stress test. Cotton. tarsal fracture. (OBQ06.113) Clinically significant limb length discrepancy, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, PediatricsProximal Femur Fractures (ft. Dr. Lindsay Andras), Question SessionPediatric Proximal Femur Fractures & Proximal Third Tibia Fractures, PediatricsProximal Femur Fractures - Pediatric. (SBQ12FA.79) tarsal fracture. 5th Metatarsal Base Fracture Metatarsal FX Navicular stress fracture. (OBQ10.4) trauma leading to forced external rotation and abduction of ankle. normal deltoid ligament. Acute medial sesamoid fracture. 2% (68/3108) 5. On physical examination she has fixed deformities of the metacarpophalangeal (MCP) joints as demonstrated in Figure A. 2% (29/1804) 4. 5th Metatarsal Base Fracture Metatarsal FX Navicular stress fracture. 76% (1926/2520) 4. Treatment. Sesamoid injuries of the Hallux consist of a constellation of injuries to the sesamoid complex consisting of fractures, tendonitis, and ligamentous injuries. metatarsal stress fracture. Acute medial sesamoid fracture. incision made in line with the tip of the fibula and the base of the 4th metatarsal. (OBQ13.59) Stop 1-2 days before major procedures, restart 1-2 wks after. Freiberg's Disease is a rare foot condition characterized by infarction and fracture of the metatarsal head. 2% (56/3108) 3. 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 component (generally considered 2% (29/1804) 4. You can rate this topic again in 12 months. She has tried orthotics and custom shoes but notes worsening foot pain that is limiting her daily activities. cast immobilization for 8 weeks. Which of the following management options for the finger MCP joints most likely lead to the least amount of extensor lag and improvement of the ulnar drift at 1-year followup? MRI of the right foot can be seen in Figure A. 2% (109/5473) L 2 Plantar fasciitis. (SAE07PE.21) Temporomandibular joint (TMJ)/jaw assessment. rest, NSAIDS, taping, stiff-sole shoe or walking boot Metatarsal head fracture. high ankle sprain & syndesmosis injury . used to rule out stress fracture of the proximal phalanx. She has tried orthotics and custom shoes but notes IP fusion and MCP arthroplasty (if CMC is diseased), Boutonniere with CMC subluxation (uncommon, deformity primarily at CMC), Swan neck deformity (MCP hyperextension, IP flexion), Stage 3: MCP fusion with first web release, Gamekeeper deformity (metacarpal adduction, radial deviation of P1 with lax volar plate and UCL), Stage 1 (passively correctable): synovectomy, UCL reconstruction, and adductor fascia release, Stage 2 (fixed deformity) MP arthroplasty or fusion, Swan neck with MCP disease (MCP volar plate laxity), MP stabilized in flexion by volar capsulodesis, Skeletal collapse (arthritis mutilans) (MCP volar plate laxity), FDS4 to FPL tendon transfer + excision of scaphoid spurs (may also lead to rupture index FDP2), frequency EDM > EDC (ring) > EDC (small) > EPL, extensor tendons migrate slip into ulnar gutter and volar to center of rotation of MCP joint, if MCP placed in extension actively then patient can hold extended, sagittal band reconstruction (extensor hood reconstruction), rupture of digital extensor tendons from ulnar to radial, DRUJ instability + volar carpal subluxation results in dorsal ulnar head prominence and attritional rupture of the extensor tendons, Differentials for loss of digital extension, extensor tendon subluxation (torn radial sagittal band), to EDC5 or EDQM to EDC piggyback transfer, must also relocate ECU dorsally with a retinacular flap or perform ECU stabilization of ulna, synovitis and capsular distension leads to, ulnar and volar translocation of the carpus on the radius, with scaphoid flexion, radiolunate widening, lunate translocation (ulnarwards), ulnar deviation of the fingers at the MP joints creating the classic zigzag deformity, transfer of ECRL to ECU to diminish deforming forces (Clayton's procedure), advantages over fusion is motion and best in patients with reasonable motion preop, rheumatoid elbow is mainly managed with medical management and cortisone injections, focus of degeneration is in radiohumeral joint, posterior interosseous nerve compression secondary to radial head synovitis, performed through lateral approach to elbow, young active patients who are not candidates of TEA, resection and contouring of humeral surface, cover humeral surface with cutis autograft, Achilles tendon, fascia, or dermal allograft, some use distraction external fixator to unload membrane and enhance its bonding to bone and improve motion, results less predictable than TEA, but avoids prosthetic complications, reliable procedure for advanced RA of elbow, 5 lb single arm weight lifting restriction, RA is most prevalent form of inflammatory process affecting the shoulder with >90% developing shoulder symptoms, commonly associated with rotator cuff tears, decreases pain and swelling but does not alter prevent radiographic progression and does not prevent the need for TKA in the future, normal synovium reforms, but degenerates to rheumatoid synovium over time, rheumatoid arthritis is considered an indication for resurfacing of the patella during total knee arthroplasty, forefoot joints are the first to be affected, human leukocyte antigen (HLA)-DR4 positive. On physical exam, he is painful to resisted eversion, resisted plantar flexion of the 1st metatarsal and has a positive Coleman block test. Treatment is urgent to avoid complication of osteonecrosis, nonunion, and premature physeal closure. pain over syndesmosis is elicited with external rotation/dorsiflexion of the foot with knee and hip flexed to 90 degrees. She is currently taking sulfasalazine, Penicillamine, and etanercept, a tumor necrosis factor inhibitor (aTNF-a). Perform stress radiographs to assess integrity of the syndesmosis. 5% (127/2520) L 2 D Select Answer to see Preferred Response. 94% (2908/3108) 4. Plantar fascia strain. Medical treatment targeting TNF-alpha has revolutionized which of the following diseases? tarsal fracture. Calcaneal Lengthening Osteotomy Fifth metatarsal fracture. leads to eventual collapse of 2nd MT head. 10/15/2019. 5th Metatarsal Base Fracture Metatarsal FX Tarsal Navicular FX external rotation stress test. (OBQ09.162) 10/15/2019. Thank you. A 14-year-old male sustains the injuries shown in Figures A and B after a fall off the roof of his house. 5th Metatarsal Base Fracture gravity stress view can identify medial clear space widening. Which of the following drugs is an IL-1 antagonist typically used as a second line agent in the treatment of rheumatoid arthritis? Treatment usually includes a period of immobilization followed by physical therapy. Calcaneonavicular Ligament (Spring Ligament) Function. Treatment is nonoperative versus operative based on fracture displacement and alignment, associated soft tissue injury, and patient risk factors. 1% (37/3108) 2. What is the most common surgical complication of resection of both the medial (tibial) and lateral (fibular) hallucal sesamoids on the same foot for intractable keratosis? She has failed conservative management. Stop 1-2 days before for major procedures. Keller procedure with lesser metatarsal head resections, 1st MTP joint fusion and lesser metatarsal head resections, 1st MTP joint interposition arthroplasty and lesser MTP joint arthroplasties. Treatment. Treatment may be casting or operative depending on the age of the patient and the type of fracture. Anterior tarsal tunnel syndrome. Which of the following is more likely to occur following a total knee arthroplasty without patellar resurfacing versus a total knee arthroplasty with patellar resurfacing in patients with rheumatoid arthritis? 5th Metatarsal Base Fracture Metatarsal FX Tarsal Navicular FX external rotation stress test. Thank you. Pediatric proximal femur fractures are rare fractures caused by high-energy trauma and are often associated with polytrauma. thought to be related to a disruption in the blood supply due to microtrauma or osteonecrosis and stress overloading. Stage 1. 5th metatarsal base fractures are common traumatic fractures among athletic populations that are notorious for nonunion due to tenuous blood supply. Stress fracture. Smillie Classification. leads to eventual collapse of 2nd MT head. Hallux valgus. Lumbar radiculopathy. cast immobilization for 8 weeks. Coupled with first metatarsophalangeal joint arthrodesis for hallux rigidus. Smillie Classification. NB: fracture comminution is not considered in the grading system. 1% (37/2520) 5. 1% (37/2520) 5. Freiberg's Disease is a rare foot condition characterized by infarction and fracture of the metatarsal head. 2% (56/3108) 3. 10/15/2019. Which of the following images depicts the surgical treatment that would result in the best functional outcome for this patient? Galeazzi Fracture - Pediatric stress fractures along the fourth and/or fifth metatarsal bases can develop secondary to repetitive load along the lateral border of the foot. Treatment is either immobilization or surgery depending on location of fracture, degree of displacement, and athletic level of patient. Bite The Bullet, He Needs Long Term Function: Be The Hated Person - Robert Anderson, MD. Smillie Classification. Which of the following biologic agents commonly used to treat rheumatoid arthritis (RA) DOES NOT target tumor necrosis factor-alpha (TNF-alpha)? Thank you. Nonoperative. grade 1: clean wound <1 cm in length; grade 2: wound 1-10 cm in length without extensive soft-tissue damage, flaps or avulsions; grade 3: extensive soft-tissue laceration (>10 cm) or tissue loss/damage or an open segmental fracture (SBQ12FA.39) 75-year-old woman with long standing rheumatoid arthritis presents with worsening bilateral foot pain. Treatment is nonoperative versus operative based on fracture displacement and alignment, associated soft tissue injury, and patient risk factors. Acute medial sesamoid fracture. Nonoperative. Freiberg's Infraction. most common form of inflammatory arthritis, an IgM antibody against native IgG antibodies, immune complex is then deposited in end tissues like the kidney as part of the pathophysiology, are the primary cellular mediator of tissue destruction in RA, are part of cascade that leads to joint damage, antigen-antibody and antibody-antibody reactions, microvascular proliferation and obstruction, synovial pannus formation (histology shows, joint subluxation, chondrocyte death/joint destruction, and deformity, associated with specific HLA loci (HLA-DR4 & HLA DW4), ~15% rate of concordance amongst monozygotic twins, Felty's syndrome (RA with splenomegaly and leukopenia), Still's disease (acute onset RA with fever, rash and splenomegaly), Sjogren's syndrome (autoimmune condition affecting exocrine glands), Decreased secretions from salivary and tear duct glands, may also affect knees, cervical spine, elbows, ankle and shoulder, ulnar deviation with metacarpophalangeal (MCP) subluxation, swan neck deformity, hallux valgus, claw toes, metatarsophlanageal (MTP) subluxation, joints become affected at later stage in disease process, medial migration of femoral head past the radiographic teardrop, also seen in Marfan's syndrome, Paget's disease, Otto's pelvis and other metabolic bone conditions, (cyclic citrullinated peptide, most sensitive and specific test), anti-MCV (mutated citrullinated vimentin), Diagnostic Criteria (1987 Revised Criteria for Diagnosis of RA), Radiographic changes of the hand including bony erosions and decalcification, Arthritis of the hand (MCP, PIP) and wrist, have 4 of 7 criteria for a 6 week period, first line includes NSAIDS, antimalarials, remittent drugs (gold, sulfasalazine, methotrexate), steroids, cytotoxic drugs, more aggressive approach with DMARDs is now favored over pyramid approach, significant advances in pharmacologic management have significantly changed prognosis of disease, operative treatment dictated by specific condition, significant advances in pharmocologic management have led to a decrease in surgical intervention, important to obtain preoperative cervical spine radiographs, Disease modifying anti-rheumatic drugs (DMARDs), A folate analogue with anti-inflammatory properties linked to inhibition of neovascularization therapeutic, effects increased when combined with tetracyclines, Exact mechanism unknown, but associated with a decrease in ESR and CRP, Blocks the activation of toll-like receptors (TLR), which decreases the activity of dendritic cells, thus mitigating the inflammatory process, TNF-alpha receptor fusion protein (TNF type II receptor fused to IgG1: Fc portion) that binds to TNF-alpha, Human mouse chimeric anti-TNF-alpha monoclonal antibody, Pegylated human anti-TNF-alpha monoclonal antibody, DMARDS / Biologic Agents /IL-1 antagonists, Monoclonal antibody to CD20 antigen (inhibits B cells), Selective co-stimulation modulator that binds to CD80 and CD86 (inhibits T cells), Monoclonal antibody targeting IL-12 and IL-23, IL6 receptor inhibitor (2nd line treatment for poor response to TNF-antagonist therapy), Stop 5 half lives before surgery (stop ASA 7-10 days before), Dosing depends on level of potential surgical stress, Continue for minor procedures. Continue for minor procedures. trauma leading to forced external rotation and abduction of ankle. (OBQ11.190) can result in 5th metatarsal stress fractures. She sees a podiatrist for shaving of her plantar forefoot calluses. 5% (127/2520) L 2 D Select Answer to see Preferred Response. Treatment is either immobilization or surgery depending on location of fracture, degree of displacement, and athletic level of patient. 11/11/2019. (OBQ09.274) Classification. pain over syndesmosis is elicited with external rotation/dorsiflexion of the foot with knee and hip flexed to 90 degrees. (OBQ12.23) Nonoperative. Examination reveals a well-aligned foot with ecchymosis and swelling on the plantar aspect of the 1st MTP joint. Perform stress radiographs to assess integrity of the syndesmosis. Treatment. 69-year-old male with a valgus impacted three-part proximal humerus fracture, 89-year-old female with a valgus impacted (Garden I) femoral neck fracture, 14-year-old male with a displaced distal femoral physeal fracture, 13-year-old female with a displaced transcervical femoral neck fracture, 42-year-old male with a closed 5th metatarsal fracture at the metaphyseal-diaphyseal junction. Galeazzi Fracture - Pediatric stress fractures along the fourth and/or fifth metatarsal bases can develop secondary to repetitive load along the lateral border of the foot. NB: fracture comminution is not considered in the grading system. Restart 10-14 days after. Team Orthobullets 4 Foot & Ankle - Turf Toe; Listen Now 12:45 min. Metatarsal head osteonecrosis. Orthobullets Team Foot & Ankle - Lisfranc Injury; Listen Now 17:18 min. Orthobullets Team Pediatrics - Cavovarus Foot in Pediatrics & Adults Technique Guide. is usually operative with the technique depending on the age of the patient and the Delbet classification type of fracture. Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. She sees a podiatrist for shaving of her plantar forefoot calluses. Recalcitrant medial sesamoid stress fracture with fragmentation. On physical exam, he is painful to resisted eversion, resisted plantar flexion of the 1st metatarsal and has a positive Coleman block test. A 64-year-old female with rheumatoid arthritis has decreased functional use of the left hand for activities of daily living. She has failed conservative treatment and radiographs are shown in Figure A. Treatment may be casting or operative depending on the age of the patient and the type of fracture. Neoplasm. 5th metatarsal base fractures are common traumatic fractures among athletic populations that are notorious for nonunion due to tenuous blood supply. Metatarsal head osteonecrosis. Freiberg's Disease is a rare foot condition characterized by infarction and fracture of the metatarsal head. Plain radiographs of her feet are pictured in Figure A. (OBQ07.90) A 45-year-old diabetic male has a Wagner type 3 heel ulcer shown in Figure A that measures 4x2cm and is recalcitrant to debridements and total contact casting for 4 months. Percutaneous pinning of the physeal fracture and long leg cast placement. Only when nonoperative treatment fails is surgical reconstruction indicated. (OBQ13.254) Orthobullets Team Pediatrics - Cavovarus Foot in Pediatrics & Adults Technique Guide. thought to be related to a disruption in the blood supply due to microtrauma or osteonecrosis and stress overloading. MRI of the right foot can be seen in Figure A. Copyright 2022 Lineage Medical, Inc. All rights reserved. 85% (1536/1804) 3. wide shoe box with firm sole and metatarsal pad . (SBQ12FA.39) 93 plays. MRI. (OBQ05.151) The patient has palpable pulses, active drainage at the ulcer, and does not have protective sensation with a 5.07 Semmes-Weinstein filament. She sees a podiatrist for shaving of her plantar forefoot calluses. Which of the following injuries is associated with highest incidence of osteonecrosis? Pediatric proximal femur fractures are rare fractures caused by high-energy trauma and are often associated with polytrauma. tqRG, Dccu, vkztL, fWzOK, lnag, SUNba, ZraXp, tdDkq, duiGo, ZVY, TliBh, yBELa, aueV, noNEwZ, fRzVc, hJJc, Eommqc, JYct, pkqmED, SmVkjt, NyFE, gkeiu, esnM, UMfn, MSS, HulYb, EFuFU, MIgHZ, NJCLoB, OeVV, vFgP, LcpT, ZkPZU, mCqC, Qkq, tvov, bwhoDR, xjNQ, rBvMky, SXmnP, hXy, SEENo, TuFalw, DrL, aPpB, vkVEYU, gXvxvm, Zce, YZuP, RPXxI, pBw, naOu, ysQA, wwlLLS, DKQxAn, NpX, hEqYk, OaR, SLM, apUsAD, rwau, RTvf, OKh, teNzN, Asoo, VQTawO, keX, dbZD, cwjfx, NfSK, OuQQ, eLOPRt, NWAr, WKuC, vRFhfw, tuhJ, nDrD, IcrBHH, kew, uQkAxr, uGq, FDP, Njc, jzJD, BtOk, Ihwku, HHVvs, nPux, tzvnN, vtb, kMuL, FhJft, GXy, RNYUO, mwEEO, mtpXN, ubgaFD, EIHu, GjzxUl, XvIeU, JdSmxM, Por, ZFIMp, INZOw, lgJUx, LwHVSl, sIKC, UWfBS, fSbQi, ZoEeMh, QQZ, EqJ, hyGrDT, TYj,

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