Orthopaedics Pearls PDF

Adam E. M.
Eltorai
Craig P. Eberson
Alan H. Daniels Editors
Essential
Orthopedic Review
Questions and
Answers for Senior
Medical Students
123
Essential Orthopedic Review
Adam E. M. Eltorai • Craig P. Eberson
Alan H. Daniels
Editors
Essential Orthopedic
Review
Questions and Answers
for Senior Medical Students
Editors
Adam E. M. Eltorai Craig P. Eberson
Warren Alpert Medical School Department of Orthopedic
Brown University Surgery
Providence, RI Warren Alpert Medical School
USA Brown University
Providence, RI
Alan H. Daniels USA
Department of Orthopedic
Surgery
Warren Alpert Medical School
Brown University
Providence, RI
USA
ISBN 978-3-319-78386-4 ISBN 978-3-319-78387-1 (eBook)

https://doi.org/10.1007/978-3-319-78387-1
Library of Congress Control Number: 2018943261
© Springer International Publishing AG, part of Springer Nature 2018

This work is subject to copyright. All rights are reserved by the Publisher, whether
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The use of general descriptive names, registered names, trademarks, service
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The publisher, the authors and the editors are safe to assume that the advice and
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The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
This book is dedicated to
my wonderfully supportive
wife Michelle and my
children Theodore and
Anne, the loves of my life.
Alan H. Daniels
To Denise and my boys,

who make everything
worthwhile.
Craig P. Eberson
For Ashley, always.

Adam E. M. Eltorai
Preface
The book is the ideal, on-the-spot reference for students

seeking fast facts on diagnosis and management in orthope-
dic surgery.
Its two-column, question-and-answer format makes it a
perfect quick reference. Organized by body part, Essential
Orthopedic Review focuses on the most common pathologic
entities. Topics include history, typical presentation, relevant
anatomy, physical examination, imaging, management, and
expected outcomes.
Essential Orthopedic Review is the ideal addition to a
white coat pocket, allowing busy students to efficiently
review fundamental principles in orthopedic surgery. Students
can read specific chapters for focused subspecialty review or
from cover to cover to lay a general foundation of orthopedic
knowledge. Aimed at helping students start their orthopedic
journeys on the right foot, this book will serve as a tool to
propel students to the next level.
Providence, RI, USA Adam E. M. Eltorai

Craig P. Eberson
Alan H. Daniels
Contents
Part I The Basics

1 Orthopaedic Terminology. . . . . . . . . . . . . . . . . . . . . . 3
Jeremy E. Raducha
2 Radiology: The Basics. . . . . . . . . . . . . . . . . . . . . . . . . 5
Hardeep Singh and Sean Esmende
3 Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Jeremy E. Raducha
4 Dislocations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Jacob Babu
5 Orthopedic Emergencies . . . . . . . . . . . . . . . . . . . . . . 11
Jacob Babu
6 Principles of Trauma. . . . . . . . . . . . . . . . . . . . . . . . . . 13
Jacob Babu
Part II The Upper Extremity
7 Upper Extremity Physical Exam. . . . . . . . . . . . . . . . 17
Tyler S. Pidgeon
8 Rotator Cuff Pathology . . . . . . . . . . . . . . . . . . . . . . . 19
Christopher Nacca
9 Adhesive Capsulitis. . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Christopher Nacca
10 Calcific Tendinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Kalpit N. Shah
x Contents
11 Proximal Humeral Fracture. . . . . . . . . . . . . . . . . . . . 25

Avi DeLano Goodman
12 Clavicular Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Jonathan Hodax
13 AC Joint Separation . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Jonathan Hodax
14 Glenohumeral Joint Pathology . . . . . . . . . . . . . . . . . 31
Devan Patel
15 Upper Extremity Arthroplasty . . . . . . . . . . . . . . . . . 33
Tyler S. Pidgeon
16 Superior Labrum Anterior to Posterior Lesions. . . 35
Jonathan Hodax
17 Biceps Tendon Ruptures. . . . . . . . . . . . . . . . . . . . . . . 37
Kalpit N. Shah
18 Humeral Shaft Fracture . . . . . . . . . . . . . . . . . . . . . . . 39
Devan Patel
19 Tennis and Golfer’s Elbow (Epicondylitis). . . . . . . 41
Andrew D. Sobel
20 Olecranon Bursitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Travis Blood
21 Distal Humerus Fractures. . . . . . . . . . . . . . . . . . . . . . 45
Devan Patel
22 Olecranon Fracture. . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Travis Blood
23 Radial Head Fractures . . . . . . . . . . . . . . . . . . . . . . . . 49
Kalpit N. Shah
24 Coranoid Fracture. . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Steven F. DeFroda
25 Elbow Dislocations. . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Devan Patel
Contents xi
26 Degenerative Joint Disease of the Elbow . . . . . . . . 55

Jeremy E. Raducha
27 Osteoarthritis of the Upper Extremity. . . . . . . . . . . 57
Devan Patel
28 Posttraumatic Arthritis: Elbow . . . . . . . . . . . . . . . . . 59
Manuel F. DaSilva
29 Radius and Ulnar Shaft Fractures. . . . . . . . . . . . . . . 61
Jeremy E. Raducha
30 Monteggia and Galeazzi Fracture/Dislocations. . . . 63
Devan Patel
31 Distal Radius and Ulnar Fractures. . . . . . . . . . . . . . 65
Travis Blood
32 Carpal Tunnel Syndrome . . . . . . . . . . . . . . . . . . . . . . 67
Andrew Paul Harris
33 Cubital Tunnel Syndrome. . . . . . . . . . . . . . . . . . . . . . 69
Kalpit N. Shah
34 Other Compressive Neuropathies. . . . . . . . . . . . . . . 71
Ross Feller
35 Kienbock’s Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Devan Patel
36 De Quervain’s Tenosynovitis. . . . . . . . . . . . . . . . . . . 75
Jeremy E. Raducha
37 Dupuytren’s Disease. . . . . . . . . . . . . . . . . . . . . . . . . . 77
Andrew Paul Harris
38 Trigger Finger. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Andrew Paul Harris
39 Scaphoid Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Andrew Paul Harris
40 Other Carpal Bone Fractures. . . . . . . . . . . . . . . . . . . 83
Devan Patel
xii Contents
41 Lunate and Perilunate Dislocations. . . . . . . . . . . . . 85

Andrew Paul Harris
42 First Metacarpal Base Fracture. . . . . . . . . . . . . . . . . 87
Travis Blood
43 Skier’s or Gamekeeper’s Thumb. . . . . . . . . . . . . . . . 89
Steven F. DeFroda
44 Boxer’s Fracture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Devan Patel
45 Phalangeal Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . 93
Kalpit N. Shah
46 Finger (Phalangeal) Dislocations . . . . . . . . . . . . . . . 95
Tyler S. Pidgeon
47 Metacarpal Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . 97
Tyler S. Pidgeon
48 Traumatic/Revision Finger Amputation. . . . . . . . . . 99
P. Kaveh Mansuripur
49 Tears of the TFCC. . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Avi DeLano Goodman
50 Carpal Instability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Avi DeLano Goodman
51 Flexor Tendon Injuries. . . . . . . . . . . . . . . . . . . . . . . . 105
Andrew D. Sobel
52 Extensor Tendon Injuries. . . . . . . . . . . . . . . . . . . . . . 109
Devan Patel
53 Nerve Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Ross Feller
54 Replantation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Steven F. DeFroda
55 Rheumatoid Arthritis and Other Inflammatory
Arthritides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Ross Feller
Contents xiii
56 Degenerative Arthritis of the Hand and Wrist . . . . 119

Ross Feller
57 Complex Regional Pain Syndrome. . . . . . . . . . . . . . 121
Ross Feller
58 Hand Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Ross Feller
Part III The Lower Extremity
59 External Snapping Hip. . . . . . . . . . . . . . . . . . . . . . . . 127
John R. Tuttle
60 Fractures of the Proximal Femur. . . . . . . . . . . . . . . . 129
Viorel Raducan
61 Native Hip Dislocations. . . . . . . . . . . . . . . . . . . . . . . 133
Viorel Raducan
62 Hip Osteoarthritis. . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Stephen Marcaccio
63 Osteonecrosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Stephen Marcaccio
64 Total Hip Arthroplasty. . . . . . . . . . . . . . . . . . . . . . . . 141
Nicholas Lemme and Alexandre Boulos
65 Femoral Shaft Fractures. . . . . . . . . . . . . . . . . . . . . . . 145
James Levins
66 Ligamentous Knee Injury. . . . . . . . . . . . . . . . . . . . . . 147
James Levins
67 Meniscal Tear. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Jonathan Hodax
68 Extensor Mechanism Injuries of the Knee . . . . . . . 151
Jonathan Hodax
69 Lower Extremity Tibia and Fibula Shaft Fractures. 153
Tyler S. Pidgeon
70 Distal Femoral Fractures . . . . . . . . . . . . . . . . . . . . . . 157
Viorel Raducan
xiv Contents
71 Patellar Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

Brian H. Cohen
72 Knee Tendon Rupture (Patellar and Quadriceps
Tendons). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
John R. Tuttle
73 Patellar Dislocation. . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Steven F. DeFroda
74 Total Knee Arthroplasty. . . . . . . . . . . . . . . . . . . . . . . 165
Alexandre Boulos and Nicholas Lemme
75 Patellofemoral Pain Syndrome . . . . . . . . . . . . . . . . . 169
Steven F. DeFroda
76 IT Band Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
John R. Tuttle
77 Lower Extremity Tibial Plateau Fractures. . . . . . . . 173
Tyler S. Pidgeon
78 Stress Fracture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
John R. Tuttle
79 Metatarsalgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Stephen Marcaccio
80 Hallux Valgus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Rishin J. Kadakia and Jason T. Bariteau
81 Heel Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Stephen Marcaccio
82 Ankle Sprain/Fracture. . . . . . . . . . . . . . . . . . . . . . . . . 183
83 Talar Fracture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Gregory R. Waryasz
84 Calcaneus Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
85 Lisfranc Fracture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Gregory R. Waryasz
Contents xv
86 Metatarsal Fracture. . . . . . . . . . . . . . . . . . . . . . . . . . . 191

Seth W. O’Donnell and Brad D. Blankenhorn
87 Pilon Fracture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
88 Achilles Tendon Pathology. . . . . . . . . . . . . . . . . . . . . 195
Gregory R. Waryasz
89 Diabetic Foot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
90 Charcot Arthropathy. . . . . . . . . . . . . . . . . . . . . . . . . . 199
91 Tarsal Tunnel Syndrome. . . . . . . . . . . . . . . . . . . . . . . 201
Brian H. Cohen
92 Peroneal Tendon Pathology. . . . . . . . . . . . . . . . . . . . 205
93 Flatfoot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
94 Plantar Fasciitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Gregory R. Waryasz
95 Morton Neuroma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
96 Arthritic Foot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
97 Pelvic Ring Fractures . . . . . . . . . . . . . . . . . . . . . . . . . 215
Daniel Brian Carlin Reid
98 Acetabular Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . 217
Part IV Spine
99 Vertebral Disc Disease. . . . . . . . . . . . . . . . . . . . . . . . 221
Dominic Kleinhenz
100 Spondylolysis and Spondylolisthesis. . . . . . . . . . . . . 223
Dominic Kleinhenz
xvi Contents
101 Spinal Stenosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

Dominic Kleinhenz
102 Spinal Cord Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Jacob Babu
103 Cervical Fracture/Dislocation . . . . . . . . . . . . . . . . . . 231
Jacob Babu
104 Thoracolumbar Fracture. . . . . . . . . . . . . . . . . . . . . . . 233
Jacob Babu
105 Lumbar Spine Conditions. . . . . . . . . . . . . . . . . . . . . . 235
Eren O. Kuris
106 Adult Spinal Deformity . . . . . . . . . . . . . . . . . . . . . . . 239
Dominic Kleinhenz
107 Spine Tumors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Eren O. Kuris
108 Spine Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Eren O. Kuris
Part V Pediatric Orthopedics
109 Angular Variations . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Heather Hansen
110 Pediatric Fractures: Management Principles. . . . . . 253
Aristides I. Cruz Jr.
111 Radial Head Dislocation . . . . . . . . . . . . . . . . . . . . . . 255
112 Slipped Capital Femoral Epiphysis. . . . . . . . . . . . . . 257
Heather Hansen
113 Congenital Hip Dislocation. . . . . . . . . . . . . . . . . . . . 259
Jose M. Ramirez
114 Congenital Coxa Vara. . . . . . . . . . . . . . . . . . . . . . . . . 261
Jose M. Ramirez
115 Osteochondrosis (Osgood-Schlatter
and Osteochondritis Dissecans). . . . . . . . . . . . . . . . . 263
Jose M. Ramirez
Contents xvii
116 Osteogenesis Imperfecta (OI). . . . . . . . . . . . . . . . . . 265

Jose M. Ramirez
117 Child Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Jose M. Ramirez
118 Legg-Calve-Perthes Disease. . . . . . . . . . . . . . . . . . . . 269
Jose M. Ramirez
119 Cerebral Palsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Heather Hansen
120 Spinal Bifida. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
121 Charcot-Marie-Tooth Disease. . . . . . . . . . . . . . . . . . 277
Heather Hansen and Seth W. O’Donnell
122 Muscular Dystrophy . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Jose M. Ramirez
123 Arthrogryposis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Jonathan R. Schiller
124 Achondroplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Heather Hansen
125 Other Skeletal Dysplasia . . . . . . . . . . . . . . . . . . . . . . 287
126 Chromosomal and Inherited Syndromes. . . . . . . . . 289
Jose M. Ramirez
127 Arthritis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Jose M. Ramirez
128 Shoulder and Elbow Deformities . . . . . . . . . . . . . . . 293
129 Hand and Wrist Deformities . . . . . . . . . . . . . . . . . . . 295
130 Genu Varum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
131 Genu Valgum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
xviii Contents
132 Axial Rotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

Jose M. Ramirez
133 Limb Deficiency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Jose M. Ramirez
134 Limb Length Discrepancy . . . . . . . . . . . . . . . . . . . . . 305
135 Pseudarthrosis of the Tibia. . . . . . . . . . . . . . . . . . . . . 307
136 Foot and Ankle Deformities . . . . . . . . . . . . . . . . . . . 309
137 Idiopathic Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
138 Neuromuscular Scoliosis. . . . . . . . . . . . . . . . . . . . . . . 313
139 Congenital Spinal Anomalies. . . . . . . . . . . . . . . . . . . 315
140 Scheuermann’s Kyphosis. . . . . . . . . . . . . . . . . . . . . . . 317
141 Cervical Spine Disorders (Pediatric) . . . . . . . . . . . . 319
142 Spondylolysis and Spondylolisthesis. . . . . . . . . . . . . 321
143 Spine Injuries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Part VI Systemic Conditions
144 Septic Arthritis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Stephen Marcaccio
145 Osteomyelitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Adam Driesman
Contents xix
146 Necrotizing Fasciitis. . . . . . . . . . . . . . . . . . . . . . . . . . . 331

Adam Driesman
147 Osteoarthritis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Sean Esmende and Hardeep Singh
148 Rheumatoid Arthritis. . . . . . . . . . . . . . . . . . . . . . . . . 335
Stuart T. Schwartz
149 Crystal-Induced Arthropathy. . . . . . . . . . . . . . . . . . . 337
James Levins
150 Fibromyalgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Deepan Dalal and Pieusha Malhotra
151 Seronegative Spondyloarthropathies . . . . . . . . . . . . 341
Eren O. Kuris
152 Polymyalgia Rheumatica . . . . . . . . . . . . . . . . . . . . . . 343
Tina Brar and Joanne Szczygiel Cunha
153 Osteoporosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
James Levins
154 Rickets and Osteomalacia Review . . . . . . . . . . . . . . 347
Jeanne Delgado
155 Chronic Kidney Disease-Mineral and Bone Disorder:
“Renal Osteodystrophy” . . . . . . . . . . . . . . . . . . . . . . 349
Janake Patel and Laura Amorese-O’Connell
156 Paget’s Disease of the Bone. . . . . . . . . . . . . . . . . . . . 351
157 Systemic Lupus Erythematosus. . . . . . . . . . . . . . . . . 353
158 Osteonecrosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
159 Benign Bone Tumors. . . . . . . . . . . . . . . . . . . . . . . . . . 357
Jose M. Ramirez, Adam Driesman,
and Richard Terek
xx Contents
160 Malignant Bone Tumors. . . . . . . . . . . . . . . . . . . . . . . 359

Adam Driesman, Jose M. Ramirez,
and Richard Terek
161 Myositis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Stuart T. Schwartz
Contributors
Laura Amorese-O’Connell, MD The Warren Alpert Medical

School of Brown University, Providence, RI, USA
Jacob Babu, MD, MHA Department of Orthopaedic Surgery,
Warren Alpert Medical School of Brown University, Rhode
Island Hospital, Providence, RI, USA
Jason T. Bariteau, MD Department of Orthopaedic Surgery,
Emory University School of Medicine, Atlanta, GA, USA
Brad D. Blankenhorn, MD Department of Orthopaedic
Surgery, Warren Alpert Medical School of Brown University,
Providence, RI, USA
Travis Blood, MD Department of Orthopaedics, Warren
Alpert Medical School of Brown University, Providence, RI,
USA
Alexandre Boulos, MD Department of Orthopaedics, Brown
University, Providence, RI, USA
Tina Brar, MD Division of Rheumatology, The Warren
Alpert School of Medicine of Brown University, Providence,
RI, USA
Brian H. Cohen, MD Department of Orthopedic Surgery,
Warren Alpert Medical School of Brown University,
Providence, RI, USA
Aristides I. Cruz Jr., MD, MBA Department of Orthopaedic
Providence, RI, USA
xxii Contributors
Joanne Szczygiel Cunha, MD Division of Rheumatology,

The Warren Alpert School of Medicine of Brown University,
Providence, RI, USA
Deepan Dalal, MD, MPH Department of Medicine-
Rheumatology, Brown University, Providence, RI, USA
Manuel F. DaSilva , MD Department of Orthopedic Surgery,
Providence, RI, USA
Steven F. DeFroda, MD, ME Department of Orthopaedic
Providence, RI, USA
Jeanne Delgado, MD Children’s National Medical Center,
Washington, DC, USA
Adam Driesman, MD Department of Orthopaedics, NYU
Langone Orthopedic Hospital, New York, NY, USA
Drs. Ramirez and Terek are at associated with Brown
Sean Esmende, MD Department of Orthopaedic Surgery,
New England Musculoskeletal Institute, University of
Connecticut School of Medicine, Farmington, CT, USA
Orthopedic Associates of Hartford, Division of Spine Surgery,
The Bone and Joint Institute, Hartford Hospital, Hartford,
CT, USA
Ross Feller, MD The Warren Alpert Medical School of
Brown University, Providence, RI, USA
Avi DeLano Goodman, MD Department of Orthopaedics,
Providence, RI, USA
Heather Hansen, MD Division of Pediatric Orthopaedic
Surgery, Department of Orthopaedics, The Warren Alpert
Medical School of Brown University, Providence, RI, USA
Andrew Paul Harris, MD Department of Orthopedic Surgery,
Providence, RI, USA
Contributors xxiii
Jonathan Hodax, MD, MS Department of Orthopedics,

Rhode Island Hospital, Providence, RI, USA
Rishin J. Kadakia, MD Department of Orthopaedic Surgery,
Emory University School of Medicine, Atlanta, GA, USA
Dominic Kleinhenz, MD Rhode Island Hospital Orthopaedic
Surgery Residency Program, Brown University of Warren
Alpert School of Medicine, Providence, RI, USA
Eren O. Kuris, MD Department of Orthopaedic Surgery,
Providence, RI, USA
Nicholas Lemme, MD Department of Orthopedics, Brown
James Levins, MD Department of Orthopaedic Surgery,
Pieusha Malhotra, MD, MPH Department of Medicine-
Rheumatology, Roger Williams Medical Center, Providence,
RI, USA
P. Kaveh Mansuripur, MD Hand and Upper Limb Surgery,
Stanford University School of Medicine, Stanford, CA,
USA
Stephen Marcaccio, MD Department of Orthopaedic
Surgery, Rhode Island Hospital, Brown University,
Providence, RI, USA
Christopher Nacca, MD Department of Orthopaedics,
Warren Alpert School of Medicine at Brown University,
Providence, RI, USA
Seth W. O’Donnell, MD Division of Pediatric Orthopaedic
Surgery, Department of Orthopaedic Surgery, Warren Alpert
Medical School of Brown University, Providence, RI, USA
Devan Patel, MD Department of Orthopaedic Surgery,
Providence, RI, USA
xxiv Contributors
Janake Patel, MD Roger William Medical Center, Boston

University, Boston, MA, USA
Tyler S. Pidgeon, MD Department of Orthopaedic Surgery,
The Warren Alpert Medical School at Brown University,
Providence, RI, USA
Viorel Raducan, MD, FRCS(C) Department of Orthopaedic
Surgery, Marshall University School of Medicine, Huntington,
WV, USA
Jeremy E. Raducha, MD Department of Orthopaedic
Providence, RI, USA
Jose M. Ramirez, MD Department of Orthopaedic Surgery,
USA
Daniel Brian Carlin Reid, MD, MPH Department of
Orthopaedics, Rhode Island Hospital, Brown University,
Providence, RI, USA
Jonathan R. Schiller, MD Adolescent and Young Adult Hip
Program, Orthopaedic Surgery, The Warren Alpert School of
Medicine of Brown University, Providence, RI, USA
Division of Pediatric Orthopaedics and Scoliosis, Hasbro
Children’s Hospital, Rhode Island Hospital, Providence, RI,
USA
Division of Sports Medicine, Hasbro Children’s Hospital,
Stuart T. Schwartz, MD Alpert Medical School of Brown
Kalpit N. Shah, MD Department of Orthopaedic Surgery,
Warren Alpert School of Medicine at Brown University,
Providence, RI, USA
Hardeep Singh, MD Department of Orthopaedic Surgery,
New England Musculoskeletal Institute, University of
Connecticut School of Medicine, Farmington, CT, USA
Contributors xxv
Andrew D. Sobel, MD Department of Orthopedics, Warren

USA
Richard Terek, MD Warren Alpert Medical School of Brown
John R. Tuttle, MD, MS Sports Medicine, Department of
Orthopaedic Surgery, Virginia Tech Carilion School of
Medicine, Roanoke, VA, USA
Gregory R. Waryasz, MD, CSCS Department of Orthopaedic
Surgery, Massachusetts General Hospital, Boston, MA, USA
Part I
The Basics
1
Chapter 1
Orthopaedic Terminology
Jeremy E. Raducha
hat do the
W ORIF? A: Open reduction
following and internal fixation
abbreviations
CRPP? A: Closed reduction and
stand for?
percutaneous pinning
WBAT? A: Weight bearing as tolerated
NWB? A: Non weight bearing
FROM? A: Full range of motion
THA? A: Total hip arthroplasty
TKA? A: Total knee arthroplasty
(continued)
American Academy of Orthopaedic Surgery. AAOS—OrthoInfo:

Glossary. American Academy of Orthopaedic Surgery webpage. http://
orthoinfo.aaos.org/glossary.cfm. Published 2017. Accessed 24 Apr 2017.
J. E. Raducha, MD
Department of Orthopaedic Surgery, Warren Alpert Medical
School, Brown University, Providence, RI, USA
© Springer International Publishing AG, part of Springer Nature 2018 3

A. E. M. Eltorai et al. (eds.), Essential Orthopedic Review,
https://doi.org/10.1007/978-3-319-78387-1_1
4 J. E. Raducha
(continued)
What is an open Fracture with communication between
fracture? the bone and outside of the skin
What is the Ligament connects bone to bone, tendon
difference between connects muscle to bone
a ligament and a
tendon?
hat is an external
W Device positioned with pins into the two
fixator? ends of a fractured bone or dislocation
with bars outside of the skin. It is used
to immobilize bones and joints. Most
commonly used while waiting for soft
tissues to become appropriate for
internal fixation
Define arthroplasty Reconstructive surgery of a joint
(i.e. joint replacement)
Define arthrodesis Surgical fusion of a joint
Define Removal of fluid from a joint
arthrocentesis
Define osteotomy Surgical procedure that changes the
alignment of bone
Define arthroscopy Surgical procedure to diagnose and treat
problems inside a joint using a minimally
invasive scope
Define sprain Partial or complete tear of a ligament
Define strain Partial or complete tear of a muscle
or tendon
Define varus Distal segment angled toward anatomic
midline
Define valgus Distal segment angled away
from anatomic midline
Chapter 2
Radiology: The Basics
Hardeep Singh and Sean Esmende
What is a systematic approach ABCS

in reading an X-ray? A: Adequacy and alignment
B: Bones
C: Cartilage (including joint
spaces)
S: Soft Tissues (effusions and
swelling)
What is the appropriate Plain X-rays in orthogonal
initial study to obtain when planes of the affected extremity
suspecting a fracture?
(continued)
H. Singh, MD
Department of Orthopaedic Surgery, New England
Musculoskeletal Institute, University of Connecticut School
of Medicine, Farmington, CT, USA
e-mail: hasingh@uchc.edu
S. Esmende, MD (*)
The Bone and Joint Institute, Hartford Hospital,
Hartford, CT, USA

https://doi.org/10.1007/978-3-319-78387-1_2
6 H. Singh and S. Esmende
(continued)
What is the study of choice Magnetic resonance imaging
when suspicious of a stress (MRI) of the affected extremity
fracture?
What is an important study Computed tomography (CT)
to obtain when evaluating a of the affected extremity for
fracture with intraarticular surgical planning
extension?
Which imaging study allows Magnetic resonance imaging
for assessment of soft tissue, (MRI)
ligaments, and tendons?
Which are the five Air, Fat, Soft tissue/Fluid,
radiographic densities? Mineral, and Metal
What are the advantages of a Allows for multiplanar
CT scan over X-rays? visualization with the ability to
reconstruct images to examine
fine bony anatomy
How is a fracture identified on Disruption (complete or
an X-ray? incomplete) in the cortex of a
bone
How are displacement, With respect to the relationship
angulation, shortening, and of the distal fragment to the
rotation described on imaging proximal fragment
studies?
Chapter 3
Fractures
Jeremy E. Raducha
What pattern
of fracture is
demonstrated a) Segmental
in images A–E? b) Comminuted
c) Sprial
d) Oblique
d) Transverse
a b c d e
hat fracture segment

W Distal segment
is used to determine the
direction of angulation?
(continued)
J. E. Raducha, MD

https://doi.org/10.1007/978-3-319-78387-1_3
8 J. E. Raducha
(continued)
Define pathological Fracture through abnormal bone (e.g.
fracture osteoporosis, tumour)
Define non-union Failure of fractured bone pieces to
fuse together after typically sufficient
healing time
What are the main types Hypertrophic, oligotrophic,
of non-union? and atrophic
Define malunion Fusion of fractured bone pieces in
inappropriate alignment
Define delayed union Longer than expected duration for
fusion of fractured bone pieces
What system is used to Gustilo and Anderson grading system
classify open fractures?
What type of antibiotic First-generation cephalosporin (e.g.
is given for a Grade I cefazolin)
or II
open fracture?
How long does the 6–8 weeks
average bone take to
heal?
Which type of bone Cancellous
heals faster, cortical or
cancellous?
Chapter 4
Dislocations
Jacob Babu
What is a feared long-term Post-traumatic arthritis

complication of any joint
dislocation?
What is the most frequently Shoulder
dislocated joint in the body?
What type of upper extremity Posterior shoulder
dislocation is commonly missed dislocation
and should be kept in mind?
What is one of the biggest Recurrent instability
concerns of shoulder dislocation (young) vs. rotator cuff tears
in the young vs. elderly patient (elderly)
population?
(continued)
J. Babu, MD, MHA

School of Brown University, Rhode Island Hospital,
Providence, RI, USA
e-mail: jacob_babu@brown.edu

https://doi.org/10.1007/978-3-319-78387-1_4
10 J. Babu
(continued)
What structures are injured in volar Central slip and volar plate
and dorsal dislocation of the hand
PIP joint, respectively?
What are the important physical Internal rotation(posterior
exam findings suggestive of dislocation) vs. external
direction of hip dislocation? rotation(anterior
dislocation) of the leg
accompanied by extremity
shortening
What is a major potential Avascular necrosis (AVN)
complication of a hip dislocation? of the femoral head
What is the appropriate initial Immediate attempted
management for a suspected knee reduction via direct axial
dislocation with asymmetric pedal traction
pulses?
What is the structure most likely to Posterior tibial tendon
block reduction of a lateral subtalar
dislocation?
Chapter 5
Orthopedic Emergencies
Jacob Babu
What should be urgently Open reduction if closed

done if skin-tenting overlying reduction is not successful in
a fracture is noticed? relieving skin pressure
What are two of the most Time to antibiotics and transfer
important factors determining to Level 1 Trauma Center
outcome after an open
fracture?
What is the classification Gustilo–Anderson classification
system commonly utilized to
describe open fractures?
What should be done next Ankle Brachial Index
if diminished pulses are
appreciated in a traumatic
lower extremity injury?
(continued)
J. Babu, MD, MHA

Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_5
12 J. Babu
(continued)
What physical exam Pain, pallor, paresthesias,
findings can be suggestive of pulselessness, paralysis
compartment syndrome?
What diagnostic test can Compartment pressure
help practitioners identify measurements compared
compartment syndrome? to diastolic blood pressure.
DBP—CP <30 is indicative of
compartment syndrome
What cell count from a joint Nucleated cell counts greater
aspiration can be suggestive than 50–80,000
of a septic joint?
What is a major consequence Articular cartilage destruction
of a missed septic joint? from bacterial toxins and
inflammatory cell enzymes
What utility can be obtained Identifying a disc herniation and
from performing an MRI optimal approach for stabilization
prior to reduction of a of fracture/dislocation
cervical facet dislocation?
What are some of the red flag Bowel/bladder incontinence
symptoms of a lumbar disc or retention, saddle anesthesia,
herniation which may indicate progressive extremity weakness
cauda equina syndrome? and numbness
Chapter 6
Principles of Trauma
Jacob Babu
What class of shock and what Class II Shock and loss of

percentage of total body blood 15–30% blood volume
loss are indicated by normal blood
pressure with an elevated heart
rate?
Transfusion of what blood products Red blood cells, platelets,
are indicated in a 1:1:1 ratio? plasma
What serum marker value is Serum lactate levels
indicative of adequate resuscitation? <2 mmol/L
How much blood can be lost into 1–2 L
the thigh from a single femur
fracture?
(continued)
J. Babu, MD, MHA

Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_6
14 J. Babu
(continued)
What Injury Severity Score (ISS) An ISS of 15. ISS = sum
is considered a major trauma with of the squares of the three
>10% mortality? highest Abbreviated Injury
Scores (AIS)
What should be done if pelvic Placement of pelvic binder
instability is identified by exam or clamped bedsheet
and radiograph and the patient is centered around patient’s
hemodynamically unstable? greater trochanters
What X-ray views can help better Inlet and outlet views
identify pelvic ring fractures?
What are the options of damage External fixation and
control orthopedics management of skeletal traction
a long bone fracture?
What radiographic finding is Displacement of the edge
indicative of a scapulothoracic of scapula from the spinous
dissociation? process by >1 cm from the
contralateral side
Is lower extremity trauma an Yes
indication for internal fixation of an
otherwise uncomplicated humeral
shaft fracture?
Part II
The Upper Extremity
15
Chapter 7
Upper Extremity Physical
Exam
Tyler S. Pidgeon
What structure is likely affected in a The Triangular

patient with a positive fovea sign? Fibrocartilage Complex
(TFCC)
Allen’s test evaluates the The ulnar artery and the
connection of which two arteries radial artery
with the palmar arches of the hand?
A positive Obrien’s test is The glenoid labrum
suspicious for an injury to what
shoulder structure?
A patient with an abnormal hook Supination
test at the elbow would be most
likely to have weakness with what
motion of the forearm?
Finkelstein’s test evaluates patients De Quervain’s
for what wrist condition? tenosynovitis (tenosynovitis
of the first dorsal
compartment of the wrist)
(continued)
T. S. Pidgeon, MD
Department of Orthopaedic Surgery, The Warren Alpert Medical
School at Brown University, Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_7
18 T. S. Pidgeon
(continued)
What is the most sensitive physical Durkan’s carpal

exam special test for the diagnosis compression test
of carpal tunnel syndrome?
A patient with pain during resisted Lateral epicondylitis
wrist extension with an extended
elbow is most likely to have what
condition?
Describe the performance and The patient is supine on
findings of apprehension testing in the examination table
a patient with suspected shoulder to stabilize the scapula.
instability The shoulder is passively
externally rotated by
the examiner with the
shoulder abducted and the
elbow flexed to 90o. The
patient complains of pain
or apprehension that the
shoulder will dislocate with
increasing external rotation.
Symptoms are improved
when the examiner applies
anterior to posterior
pressure over the shoulder
Testing of thumb interphalangeal The anterior interosseous
joint flexion strength and index nerve (branch of the
finger distal interphalangeal joint median nerve)
strength examines the function of
what nerve?
Positive Tinel’s sign over the Cubital tunnel syndrome
medial elbow is suggestive of what (ulnar nerve compression
condition? neuropathy)
Chapter 8
Rotator Cuff Pathology
Christopher Nacca
How many rotator cuff tendons Four

exist?
Name the rotator cuff tendons Supraspinatus, infraspinatus,
[1, 2]. subscapularis, teres minor
What is the innervation of the Axillary nerve
Teres minor?
Where does the subscapularis Lesser tuberosity
insert?
Which side of the tendon do Articular side
most tears occur?
Name structures within the Capsule, SGHL,
rotator interval. coracohumeral ligament
(continued)
C. Nacca, MD
Department of Orthopaedics, Warren Alpert School of Medicine at

https://doi.org/10.1007/978-3-319-78387-1_8
20 C. Nacca
(continued)
Majority of tears include which Supraspinatus, infraspinatus

tendons?
Which symptom is a poor Night pain
indicator for nonoperative
management?
Hornblower’s sign is often Teres minor
associated with which tendon
tear?
What is the treatment for Reverse total shoulder
patients with massive rotator arthroplasty
cuff tears and associated
glenohumeral arthritis
References
1. Millett PJ, Warth RJ. Posterosuperior rotator cuff tears. J Am
Acad Orthop Surg. 2014;22(8):521–34. https://doi.org/10.5435/
JAAOS-22-08-521.
2. Murray J, Gross L. Optimizing the management of full-thickness
rotator cuff tears. J Am Acad Orthop Surg. 2013;21(12):767–71.
https://doi.org/10.5435/JAAOS-21-12-767.
Chapter 9
Adhesive Capsulitis
Christopher Nacca
Which structure in the shoulder is Joint capsule

most often involved? [1]
How many stages of progression Four
are there?
What is the most common Pain of insidious onset over
presentation? several months
Patients often complain having Sleeping on affected side,
difficulty with which activities? combing hair, or reaching
behind back
Who are the most common Women aged 40–60 years old
demographic affected?
Which endocrine disorders are Diabetes and hypothyroidism
often implicated?
How is this condition best Physical exam
diagnosed?
(continued)
C. Nacca, MD
Department of Orthopaedics, Warren Alpert School of Medicine at

https://doi.org/10.1007/978-3-319-78387-1_9
22 C. Nacca
(continued)
Which exam finding is most Limited passive range of
specific? motion in external rotation
What is the mainstay of Intra-articular corticosteroid
treatment? injection and physical
therapy
How much time may it take for Up to 2 years
resolution of symptoms with
nonoperative treatment?
References
1. Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder.
J Am Acad Orthop Surg. 2011;19(9):536–42. http://www.ncbi.nlm.
nih.gov/pubmed/21885699. Accessed 12 Jul 2017.
Chapter 10
Calcific Tendinitis
Kalpit N. Shah
What is calcific tendinitis? Calcification and tendon deposition

of the rotator cuff tendons at their
insertion on the humerus
Who are the typical Women aged 30–60 years
patients that develop
calcific tendinitis?
Which is the most common Supraspinatus
tendon involved?
Which medical Endocrine abnormalities—
comorbidities are risk Hypothyroidism, diabetes
factors?
What are the three phases Formative (calcium deposits being
of calcific tendinitis? made)
Resting (no inflammatory activity)
Resorptive (phagocytic
resorption—inflammatory
mediators cause a significant
amount of pain)
(continued)
K. N. Shah, MD
Department of Orthopaedic Surgery, Warren Alpert School of
Medicine at Brown University, Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_10
24 K. N. Shah
(continued)
Which physical exam Subacromial impingement tests
maneuvers are positive?
What imaging modality is Shoulder radiographs should show
ideal? the calcium deposits at the insertion
side of the various tendons
Where are the calcium 1–1.5 cm away from the tendon
deposits located? insertion
What is the first-line Conservative: NSAIDs, therapy—
treatment for calcific stretching, strengthening, +/−
tendinitis? steroid injections
What % of patients will 60–70% of patients by 6 months
improve with nonoperative
management?
What are the treatment Extracorporeal shockwave therapy
options if patient fails Needle barbotage
conservative management? Surgical debridement
Chapter 11
Proximal Humeral Fracture
Avi DeLano Goodman
What X-ray views are Trauma series: true AP, axillary

needed? lateral, scapular Y
What defines a “part” in 1 cm displacement or 45° angulation.
the Neer classification? Parts can be: greater tuberosity,
lesser tuberosity, articular surface,
and shaft
Which is the most Surgical neck (85%)
common type of fracture?
What is the incidence of 45%, axillary nerve
nerve injury, and which
nerve is most commonly
injured?
What is the blood supply Anterior humeral circumflex artery
to the humeral head? (old data), posterior humeral
circumflex artery (new data)
(continued)
A. D. Goodman, MD
Department of Orthopaedics, Warren Alpert Medical School
of Brown University, Providence, RI, USA
e-mail: avi_goodman@brown.edu

https://doi.org/10.1007/978-3-319-78387-1_11
26 A. D. Goodman
(continued)
What is attached to each Greater: rotator cuff (will displace
tuberosity? superiorly and posteriorly)
Lesser: subscapularis (will rotate
internally)
When to consider Minimally displaced, greater
nonoperative tuberosity displacement <5 mm, low
management? demand, otherwise not medically
able to undergo surgery
What are the surgical ORIF, intramedullary nail, CRPP,
options? and arthroplasty (hemiarthroplasty,
anatomic total, and reverse total)
What are the common Intraarticular screw penetration,
complications? avascular necrosis, malunion,
nonunion, rotator cuff injury,
posttraumatic arthritis, stiffness
Chapter 12
Clavicular Fracture
Jonathan Hodax
How is the clavicle formed in Intramembranous ossification

embryology and childhood
development?
What is special about First bone to begin to ossify, last
the clavicle’s timing of to finish
ossification?
What side does congenital RIGHT side, believed to be
pseudoarthrosis of the because of the brachiocephalic
clavicle typically occur on artery
and why?
How are clavicle fractures Medial, middle, and lateral third
typically grouped?
How are medial clavicle Anterior versus posterior
fractures classified? displacement
(continued)
J. Hodax, MD, MS
Department of Orthopedics, Rhode Island Hospital,
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_12
28 J. Hodax
(continued)
How are middle third clavicle Typically displaced versus
fractures classified? nondisplaced, comminuted versus
not
How are lateral third clavicle Neer classification, type I–V
fractures classified?
What ligaments attach to the Costoclavicular ligament medially,
clavicle? and the conoid and trapezoid
coracoclavicular ligaments
laterally
What are the absolute Open fracture, threatened skin,
indications to operate on subclavian injury
a middle third clavicle
fracture?
What are the relative Displacement greater than 100%,
indications to operate on “Z” deformity, comminution,
a middle third clavicle shortening more than 2 cm,
fracture? polytrauma
What is the most common Hardware removal
cause for reoperation after
fixation of clavicle fractures?
Chapter 13
AC Joint Separation
Jonathan Hodax
How are AC By the Rockwood classification

separations classified? I: Symptomatic sprain without
radiographic displacement
II: Coracoclavicular interval widening
of up to 25% compared with
contralateral III: Coracoclavicular
interval widening of 25–100%
IV: Clavicle displaced posteriorly into/
through trapezius
V: Clavicle displaced more than 100%
superiorly, lateral end through
deltotrapezial fascia
VI: Inferiorly displaced lateral clavicle,
with clavicle resting posterior to
coracobrachialis tendon
What X-rays are best Zanca view and comparative images of
to evaluate AC joint the uninjured shoulder
injuries?
(continued)
J. Hodax, MD, MS
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_13
30 J. Hodax
(continued)
What AC separations Type IV and higher are generally
are appropriate for operatively treated. Type III are
surgical intervention? operative in athletes or those who fail
nonop treatment
What surgical Allograft reconstruction with tendon
techniques exist for looped around the coranoid, screw
repairing the AC fixation to the coranoid, and suture
joint? fixation of the clavicle to the coranoid
What portion of the The posterosuperior joint capsule
AC joint capsule is
strongest?
Chapter 14
Glenohumeral Joint
Pathology
Devan Patel
Is anterior or posterior Anterior

instability more common?
What is TUBS? Traumatic unilateral shoulder
dislocations, with a Bankart lesion
often requiring surgery
What is AMBRI? Atraumatic multidirectional bilateral
shoulder dislocation often requiring
rehabilitation and occasionally
requiring inferior capsular shift
What is a Bankart lesion? Disruption of the anterior inferior
glenoid labrum, often a result of
anterior shoulder dislocations
What is a Hill Sachs Impaction injury to the posterior
lesion? superior humeral head, often seen
after an anterior dislocation
(continued)
D. Patel, MD
e-mail: Devan_Patel@brown.edu

https://doi.org/10.1007/978-3-319-78387-1_14
32 D. Patel
(continued)
What is the “lightbulb” Appearance of the humeral head
sign? in internal rotation on an AP
radiograph seen after a posterior
shoulder dislocation
What is a HAGL lesion? Humeral avulsion of the inferior
glenohumeral ligament, most
commonly seen after an anterior
shoulder dislocation
What incidents typically High-energy trauma, seizures, and
cause posterior electrocution accidents
dislocations?
Which muscle group is the Shoulder internal rotators overpower
primary cause of posterior external rotators
shoulder dislocations?
What portion of the Posterior glenoid
glenoid typically
appears most worn in
osteoarthritis of the
glenohumeral joint?
Chapter 15
Upper Extremity
Arthroplasty
Tyler S. Pidgeon
Total shoulder arthroplasty is Rotator cuff deficiency

contraindicated in patients with what (large and irreparable
soft-tissue shoulder pathology? full-thickness tears/non-
functional rotator cuff/
rotator cuff arthropathy)
What shoulder arthroplasty options Reverse total shoulder
are available to patients with rotator arthroplasty and shoulder
cuff deficiency? hemiarthroplasty
Reverse total shoulder arthroplasty Deltoid
function relies on the function of
what muscle?
Total shoulder arthroplasty in Glenoid component
patients with rotator cuff deficiency loosening and failure
fails most commonly by what
mechanism?
(continued)
T. S. Pidgeon, MD

https://doi.org/10.1007/978-3-319-78387-1_15
34 T. S. Pidgeon
(continued)
What indication for total elbow Rheumatoid arthritis
arthroplasty results in the longest
survivorship?
What is the lifelong lifting restriction Repetitive activity: 2
for patients who have undergone pounds; Single lift activity:
total elbow arthroplasty? 5–10 pounds
The latest generation (fourth 90–97%
generation) total wrist arthroplasty
designs have approximately what
5-year survival rate?
Thumb carpal-metacarpal (CMC) The trapezium
joint arthroplasty most commonly
involves resection of what carpal
bone?
Attenuation of what ligament is The anterior oblique
thought to be a major contributing (Beak) ligament (primary
cause of thumb CMC arthritis? stabilizer of the thumb
CMC joint)
Silicon metacarpophalangeal Rheumatoid arthritis
(MCP) joint replacement of the
index, middle, ring, and small finger
during the same operation is most
commonly performed for patients
with what disease?
Chapter 16
Superior Labrum Anterior
to Posterior Lesions
Jonathan Hodax
How are SLAP tears By the Tuoheti classification

classified? I: Fraying of the superior labrum with an
intact biceps anchor
II: Superior labral detachment with
detachment of the biceps anchor
III: Bucket-handle type tear of the
superior labrum, biceps anchor intact
IV: Bucket handle tear of the labrum with
extension into the biceps tendon, anchor
partially intact
How are SLAP tears Type I: Debride frayed edge
typically treated? Type II: Debride and reattach biceps and
labrum
Type III: Resect tear, anchor free edges if
needed
Type IV: Resect tear. If >50% of biceps
tendon involved, consider tenodesis
(continued)
J. Hodax, MD, MS
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_16
36 J. Hodax
(continued)
In what population Overhead throwing athletes
are SLAP tears most
clinically significant?
What is a cordlike A Buford complex, and NO!
MGHL with absence
of the anterior
labrum called?
And should this be
repaired down?
What is the major Overconstraint of the biceps tendon
surgical pitfall to leading to reduced range of motion
avoid in SLAP
repairs?
Chapter 17
Biceps Tendon Ruptures
Kalpit N. Shah
Where do the two heads of Coracoid process (short head)

the biceps tendon originate and the superior glenoid (long
from? head)
Where does the biceps Bicipital tuberosity of the radius
tendon attach distally? Long head attaches proximally
Short head attaches distally
Where does the lacertus Comes off the medial side of the
fibrosus originate and insert? short head of the biceps tendon in
the antecubital fossa
Crosses the antecubital fossa and
is continuous with the deep fascia
of the flexor muscle bellies
What innervate the biceps Musculocutaneous nerve
muscle?
(continued)
K. N. Shah, MD
Department of Orthopaedic Surgery, Warren Alpert School
of Medicine at Brown University, Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_17
38 K. N. Shah
(continued)
What type of contraction Eccentric contraction—forced
leads to tendon injury? elbow extension when flexed
Can patients with biceps Yes, brachialis muscle is the
tendon rupture flex their primary elbow flexor. Biceps
elbow? brachii contributes 30% of elbow
flexion strength
Can patients with biceps Yes, supinator contributes to
tendon ruptures supinate forearm supination. Biceps brachii
their arm? contributes roughly 40–50% of
the supination strength
Physical exam test to assess Hook test—examiner tries to
distal biceps tendon? hook their index finger into the
patient’s biceps tendon in the
antecubital fossa
If a patient has a known Lacertus fibrosus
distal biceps tear, but still has
a negative hook test, what
structure is the examiner
palpating?
What deformity does a Popeye deformity
patient with a biceps rupture
have on examination?
Best imaging test to evaluate MRI with the forearm flexed,
for this injury? supinated, and shoulder abducted
What nerve is at risk of being Posterior interosseous nerve and
injured during surgical repair lateral antebrachial cutaneous
of distal biceps tendon? nerve
Chapter 18
Humeral Shaft Fracture
Devan Patel
How can humeral shaft Transverse, oblique, spiral, comminuted

fracture patterns be with or without butterfly fragments
described?
What are the primary Pectoralis major: adducts proximal
deforming forces of fracture fragments
humeral shaft fractures? Deltoid: abducts proximal fracture
fragments
What are the maximum Malrotation: 15°
acceptable reduction Anterior angulation: 20°
criteria for nonoperative Varus: 30°
management? Shortening/bayonet opposition: 3 cm
(continued)
D. Patel, MD

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40 D. Patel
(continued)
What is the classic High energy trauma → direct
mechanism of humeral force → transverse and comminuted
shaft fractures? fractures
Indirect trauma (fall on outstretched
hand) → rotational forces → spiral
fracture patterns
What are some Radial nerve injuries, brachial plexus
associated injuries, and profunda brachii arteries
neurovascular injuries
with humeral shaft
fractures?
What are the Open fractures, unacceptable reduction
indications for operative criteria, radial nerve palsy after
management? reduction, ipsilateral upper extremity
injuries, pathological fractures, and
segmental fractures
What is the most Coaptation splint followed by
common nonoperative Sarmiento brace or casting
treatment?
What are the operative Intramedullary nail, plate fixation, and
treatments for humeral external fixation
shaft fractures?
Common complications Radial nerve palsy, malunion, delayed
of a humeral shaft union, non-union
fracture include?
Chapter 19
Tennis and Golfer’s Elbow
(Epicondylitis)
Andrew D. Sobel
What is the most common Extensor carpi radialis brevis

muscle origin affected (ECRB)
in tennis elbow (lateral
epicondylitis)?
What is the histopathology of Angiofibroblastic hyperplasia and
lateral epicondylitis? disorganized collagen
What are the two most Tenderness to palpation at lateral
common findings on epicondyle/insertion of ECRB
examination of lateral
Pain with wrist extension
epicondylitis?
against resistance
What is a common non- Radial tunnel syndrome which
traumatic condition that can has pain more distal (3–4 cm)
often be confused with lateral from the lateral epicondyle and
epicondylitis and how can you pain with extension of the long
differentiate them on exam? finger
(continued)
A. D. Sobel, MD
Department of Orthopedics, Warren Alpert Medical School of

https://doi.org/10.1007/978-3-319-78387-1_19
42 A. D. Sobel
(continued)
What is the most effective Nonoperative with grip training
treatment for lateral (gripping/lifting with forearm
epicondylitis? supinated instead of pronated),
physical therapy, corticosteroid
injections, etc.
What is the cause of golfer’s Repetitive eccentric loading of
elbow (medial epicondylitis)? flexor-pronator mass usually
affecting all muscles except the
palmaris longus
What neurologic disorder is Ulnar nerve compression/neuritis
often concomitantly present
with medial epicondylitis?
What are classic exam Tenderness to palpation 5–10 mm
findings for medial distal and anterior to the medial
epicondylitis? epicondyle and pain/weakness
with resisted wrist flexion,
forearm pronation, or grip
What is the most effective Nonoperative with counterforce
treatment for medial bracing/taping, flexor-pronator
epicondylitis? mass stretching/strengthening.
Corticosteroid injections should
not be repeated multiple times
Chapter 20
Olecranon Bursitis
Travis Blood
What blood tests should CBC with differential, ESR, CRP

be obtained with suspected
infectious olecranon
bursitis?
What can you do to test the Sterile aspiration
fluid of the bursa?
What should you send the Gram stain and culture
aspiration for?
What is the most likely Staphylococcal aureus
organism that is isolated
from infected elbow
bursitis?
What nerve is on the medial Ulnar nerve
side of the olecranon?
Is elbow bursitis usually Non-painful
painful or non-painful?
T. Blood, MD
Department of Orthopaedics, Warren Alpert Medical School of
e-mail: travis_blood@brown.edu

https://doi.org/10.1007/978-3-319-78387-1_20
Chapter 21
Distal Humerus Fractures
Devan Patel
What is the general OTA/AO

classification of distal A—Extra-artricular (supracondylar)
humerus fractures? B—Partial articular (single column)
C—Complete articular (bicolumn)
What is the classification The Milch classification system
system for partial articular I: Lateral trochlear ridge intact
single column fractures? II: Fracture through the lateral
trochlear ridge
What is the classification The Jupiter classification system
system for complete
articular bicolumn
fractures?
What imaging modality is Computed tomography (CT)
important to better define scanning
these fracture patterns?
(continued)
D. Patel, MD

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46 D. Patel
(continued)
What is the “double arch” Seen on lateral radiographs in
sign? coronal sheer fractures of the
capitellum.
When is nonoperative Nondisplaced fractures, patients who
management the are not surgical candidates due to
treatment of choice? other medical comorbidities, and
advanced dementia
What is the “bag of bones” Nonoperative treatment of distal
technique? humerus fractures in a sling, used
in patients with severe medical
comorbidities
What are some operative Closed reduction with percutaneous
options? pinning, open reduction internal,
distal humeral replacement, and total
elbow arthroplasty
What are the surgical Triceps splitting, triceps sparing,
approaches to the elbow? triceps reflecting, and olecranon
osteotomy
What are some common Stiffness, heterotopic ossification,
complications? ulnar nerve palsy, nonunion, and
malunion
Chapter 22
Olecranon Fracture
Travis Blood
What tendon attaches to the Triceps tendon

posterior olecranon?
What is the most common Tension-band wiring
treatment option for a simple
transverse olecranon fracture?
What articulates with the Trochlea of the distal humerus
greater sigmoid notch of the
ulna to form one of the elbow
joints?
What is the purpose of the Increase extension arc
olecranon fossa of the elbow? of motion and decrease
impingement
(continued)
T. Blood, MD

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48 T. Blood
(continued)
If there is an olecranon fracture Anteriorly
and dislocation of the radius
what direction will the radius
most likely dislocate?
What are the treatment Tension band wiring, plate and
options for displaced olecranon screw fixation, intramedullary
fractures? rod, excision and triceps
advancement
What is the number one reason Removal of hardware, hardware
for return to operating room irritation
after fixation of olecranon
fracture?
Chapter 23
Radial Head Fractures
Kalpit N. Shah
What position of the arm Elbow fully extended and forearm

during a fall causes a radial pronated
fracture?
What is the terrible triad of Elbow dislocation, radial head
the elbow? fracture, and coronoid fracture
What is an Essex-Lopresti Radial head fracture, interosseous
injury? membrane disruption, DRUJ injury
Most common classification Mason classification
for radial head fractures? Type I: Nondisplaced
Type II: Displaced (>2 mm) with
rotation block
Type III: Comminuted and
displaced
Type IV: Elbow
dislocation + radial head fracture
(continued)
K. N. Shah, MD
of Medicine at Brown University, Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_23
50 K. N. Shah
(continued)
How to assess a block to Aspirate elbow hematoma and
forearm rotation in the inject lidocaine (reduces pain
setting of a radial head associated with the fracture)
fracture?
What is important if Early ROM (after few days in a
managing a nondisplaced sling) to avoid elbow stiffness
radial head nonoperatively?
Surgical treatment options ORIF, partial excision, full excision,
for radial head fractures? radial head replacement
Fragments under what size Fragments<25% radial head
should be excised? articular surface should be excised
How to decide between Replace the radial head if more
fragment excision vs. radial than three fragments need to be
head replacement? excised
Which nerve is at risk PIN—Avoid damaging this nerve
during a surgical approach with pronation of the forearm
to the radial head?
What are safe zones for 90° arc on the radial head that is in
ORIF of radial head? line with the radial styloid to the
bicipital tuberosity
Chapter 24
Coranoid Fracture
Steven F. DeFroda
What injury is most associated with Elbow dislocation

coranoid fracture?
What important anatomic structure Anterior capsule of the
attaches just distal to the coranoid elbow
tip?
What is a “terrible triad” injury? Coranoid fracture, elbow
dislocation, radial head
fracture
Define the Regan and Morrey Type 1: Coranoid tip
classification Type 2: <50% of coranoid
Type 3: >50% of coranoid
Is the coranoid an intra- or Intra-articular
extra-articular structure?
Where does the medial ulnar Medial facet
collateral ligament insert?
S. F. DeFroda, MD, ME

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52 S. F. DeFroda
References
1. Chen NC, Ring D. Terrible triad injuries of the elbow. J Hand Surg
Am. 2015;40(11):2297–303. https://doi.org/10.1016/j.jhsa.2015.
04.039.
Chapter 25
Elbow Dislocations
Devan Patel
How are elbow dislocation The olecranon (distal) compared

discribed in terms of to the humerus (proximal)
direction?
What is the most common Posterolateral
type of elbow dislocation?
What are the primary static Joint capsule, anterior bundle
stabilizers of the elbow? of the medial collateral ligament,
lateral collateral ligament complex,
joint congruity
What are the dynamic Anconeus, brachailis, and triceps
stabilizers of the elbow?
In what direction do the Lateral to medial, from the LCL
stabilizing elements of to the MCL
the elbow fail during a
dislocation?
(continued)
D. Patel, MD

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54 D. Patel
(continued)
What are surgical Open injuries, gross instability
indications for an elbow of the elbow, and other elbow
dislocation? fractures that warrant operative
intervention
What is the typical 90° of flexion with forearm
position of splinting elbow pronation
dislocations?
What is the terrible triad? Elbow dislocation with a radial
head and coronoid fracture
What are the complications Stiffness, pain, and instability
of elbow dislocations?
Chapter 26
Degenerative Joint Disease
of the Elbow
Jeremy E. Raducha
What type of collagen is found Type II collagen

most commonly in articular
cartilage?
What are the three articulations Ulnotrochlear,
of the elbow? radiocapitellar, and proximal
radioulnar joints
What is the most common cause Rheumatoid arthritis
of elbow arthritis?
(continued)
Sanchez-Sotelo J, Morrey BF. Total elbow arthroplasty. J Am Acad

Orthop Surg. 2011;19(2):121–5. http://www.ncbi.nlm.nih.gov/pubmed/
21292935. Accessed 24 Apr 2017.
Kokkalis ZT, Schmidt CC, Sotereanos DG. Elbow arthritis: current con-
cepts. J Hand Surg Am. 2009;34(4):761–8. doi:10.1016/j.jhsa.2009.02.019.
Soojan MG, Kwon YW. Elbow arthritis. Bull NYU Hosp Jt Dis.
2007;65(1):61–71. http://presentationgrafix.com/_dev/cake/files/archive/
pdfs/526.pdf. Accessed 26 Apr 2017.
J. E. Raducha, MD

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56 J. E. Raducha
(continued)
Which motion is typically lost first Terminal extension
in elbow arthritis?
Which nerve is most likely affected Ulnar nerve
by end stage elbow arthritis?
Which indication for total elbow Rheumatoid arthritis
arthroplasty has the highest
survivorship?
What are the absolute Active infection
contraindications for total elbow and charcot joint
arthroplasty?
What is the most common Infection
complication following total elbow
arthroplasty?
Chapter 27
Osteoarthritis of the Upper
Extremity
Devan Patel
What are the symptoms Joint pain, swelling, decreased range

of osteoarthritis? of motion, and tenderness
What are the radiographic Osteophyte formation, sclerosis,
findings of osteoarthritis? joint space narrowing, and
subchondral cysts
What are Heberden Palpable osteophytes of the distal
nodes? interphalangeal joint in the finger
Why is osteoarthritis Increased force through this joint
in the DIP joints so relative to others in the hand
common?
What are Bouchard’s Palpable osteophytes of the proximal
nodes? interphalangeal joint in the finger
may occur due to osteoarthritis or
rheumatoid arthritis
(continued)
D. Patel, MD

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58 D. Patel
(continued)
Laxity in what ligament is Anterior oblique ligament
thought to contribute to (beak ligament)
thumb CMC arthritis?
What are some physical Positive CMC grind test, “Z deformity,”
exam findings seen in and adduction deformity
CMC arthritis?
What are some Activity modification, NSADIS,
conservative treatments steroid injections, and braces
to CMC arthritis?
What are surgical Trapezium resection, ligament
treatment options for reconstruction with or without
CMC arthritis? tendon interposition, osteotomy,
and arthrodesis
Chapter 28
Posttraumatic Arthritis:
Elbow
Manuel F. DaSilva
What is the physiologic ROM 0–146 extension/flexion; 71°

of the elbow? of forearm pronation and 84°
of forearm supination
What is the elbow ROM 30–130° of flexion and extension
required for most ADLs?
What is the best imaging 3D reconstruction CT technology
modality to assess complex
deformity?
How do you test for potential Elbow aspiration for cell count
infection preoperatively? with differential and cultures
What part of the medial Anterior bundle of the MCL
collateral ligament (MCL)
must be preserved during
surgical release?
(continued)
M. F. DaSilva, MD
Department of Orthopedic Surgery, Warren Alpert Medical School
e-mail: Manuel_Dasilva@brown.edu

https://doi.org/10.1007/978-3-319-78387-1_28
60 M. F. DaSilva
(continued)
To increase flexion doing Posterior bundle of the MCL
surgical release what part of
the MCL ligament must be
released?
Define ulnohumeral Open or arthroscopic procedure
arthroplasty. that removes impinging
osteophytes or loose bodies,
synovectomy, and capsular release
What is the clinical Lateral sided elbow pain with
presentation of patients recurrent effusions
with isolated radiocapitellar
arthritis?
What is the common location Coronoid and olecranon fossae
for osteophytes that block
motion?
What is the most common Ulnar neuropathy
nerve complication of
ulnohumeral arthroplasty?
What are the restrictions 10 lbs for single lift and under
for patients with total elbow 2–5 lbs for repetitive lifting
arthroplasty?
Chapter 29
Radius and Ulnar Shaft
Fractures
Jeremy E. Raducha
In addition to radius/ulna Ipsilateral elbow and wrist

views which radiograph tests radiographs
are required in patients with
forearm fractures?
What type of splint is used to Sugartong
initially immobilize radius/ulna
diaphysis fractures?
(continued)
Baratz ME. Disorders of the forearm axis. In: Wolfe SWM, editor. Green’s
operative hand surgery. 7th ed. Philadelphia: Elsevier; 2017. p. 786–812.
https://www-clinicalkey-com.revproxy.brown.edu/service/content/pdf/
watermarked/3-s2.0-B9781455774272000216.pdf?locale=en_US. Accessed
18 Apr 2017.Gaulke R. Diaphyseal fractures of the forearm. In: Browner B,
et al., editor. Skeletal trauma: basic science, management, and reconstruction.
5th ed. Philadelphia: Elsevier-Saunders; 2015. p. 1313–47. https://www-clini-
calkey-com.revproxy.brown.edu/service/content/pdf/watermarked/3-s2.
0-B9781455776283000454.pdf?locale=en_US. Accessed 23 Apr 2017.
J. E. Raducha, MD

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62 J. E. Raducha
(continued)
What is a “both bone” fracture? Fracture of both the radius and
ulna at the same level
What is a “nightstick” fracture? Isolated ulnar shaft fracture
What percent displacement <50% displacement and
is allowed for nonoperative <10° angulation
treatment in a stable ulnar shaft
fracture?
What is the most important Restoration of the radial bow
variable in a functional outcome
following radial and ulnar
ORIF?
What approaches are used for Volar approach of Henry and
radial shaft ORIF? dorsal (Thompson) approach
What are complications of Infection, synostosis, nonunion,
radial/ulna ORIF? malunion, compartment
syndrome, neurovascular injury,
re-fracture
What factor is associated with Premature plate removal,
re-fracture of a surgically fixed comminuted fracture, large
radius/ulna fracture? plate, persistent lucency on
X-ray
Chapter 30
Monteggia and Galeazzi
Fracture/Dislocations
Devan Patel
What is a Monteggia fracture? Proximal ulna fracture with a

radial head dislocation
What is the common The Bado system
classification system for Type I—Proximal/middle ulna
Monteggia fractures? fracture with an anterior radial
head dislocation(most common)
Type II—Proximal/middle ulna
fracture with a posterior radial
head dislocation
Type III—Proximal/middle ulna
fracture with a lateral radial
head dislocation
Type IV—Proximal/middle ulna
and radius fracture with a radial
head dislocation
(continued)
D. Patel, MD

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64 D. Patel
(continued)
What nerve can be injured Posterior Interosseus Nerve
in patients with Monteggia (PIN) injury
fractures?
What is the typical mechanism Fall on outstretched arm in
of injury in a Monteggia hyperpronation
fracture?
What is a Galeazzi fracture? Distal third radius fracture
with a distal radial ulnar joint
dislocation
What are some radiographic DRUJ widening greater than
findings indicative of a DRUJ 5 mm
injury? Ulnar styloid fracture
Radial shortening
What are the deforming forces Brachioradialis → pulls distal
in a Galeazzi fracture? fragment proximally
Pronator quadratus → pronates
the fragment and pulls it volarly
What is the typical treatment Operative to achieve, fixation of
for Galeazzi fractures? the radius and stabilization of
the DRUJ
What is an Essex-Lopresti A radial head fracture with an
lesion? associated interosseus membrane
and DRUJ disruption
What are key physical exam DRUJ tenderness and DRUJ
findings of a DRUJ injury? instability (piano key test)
Chapter 31
Distal Radius and Ulnar
Fractures
Travis Blood
What test should be ordered on an Dexa scan

elective basis after an elderly female has a
distal radius fracture?
After fixation of a distal radius fracture Distal radial-ulnar
what joint needs to be checked for joint
stability?
What is the eponym of an extra-articular Colles fracture
dorsally displaced distal radius?
What is the eponym of an extra-articular Smiths fracture
volarly displaced distal radius?
What is the normal volar tilt of the distal 11°
radius?
What is the acceptable volar tilt after 5° dorsal to 20° volar
reduction?
(continued)
T. Blood, MD

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66 T. Blood
(continued)
What is the acceptable articular step off? 2 mm
Do you have to fix associated ulnar styloid Generally, these do
fractures? not need to be fixed
What soft tissue structure attaches at Triangular
the base of the ulnar styloid that can be fibrocartilage
injured during a distal radius fracture? complex
What nerve is compressed in acute carpal Median nerve
tunnel syndrome?
Chapter 32
Carpal Tunnel Syndrome
Andrew Paul Harris
Carpal tunnel syndrome is Median nerve

caused by neuropathy of what
nerve?
What digits are most commonly Thumb, index, middle, and
affected by carpal tunnel radial half of the ring finger
syndrome?
What are some conditions Diabetes, hypothyroidism,
associated with a higher risk pregnancy, and obesity
of developing carpal tunnel
syndrome?
Volar dislocation of what carpal Lunate
bone is associated with acute
carpal tunnel syndrome?
What symptoms do patients with Night pain, pins and needles,
carpal tunnel syndrome often numbness, weakness, dropping
report? objects (clumsiness)
(continued)
A. P. Harris, MD

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68 A. P. Harris
(continued)
What nonsurgical treatments Wrist night splints,
can be implemented to decrease corticosteroid injections
symptoms?
What ligament forms the roof of Transverse carpal ligament
the carpal tunnel?
What physical exam tests can be Durkan’s, phalen’s, reverse
done to aid in the diagnosis of phalen’s, and tinel’s tests
carpal tunnel syndrome?
Night splints used to treat carpal Neutral
tunnel syndrome should place
the wrist in what position?
What diagnostic test can be Electromyography and nerve
performed to determine the conduction study (EMG/NCS)
severity of median nerve
neuropathy in carpal tunnel
syndrome?
Chapter 33
Cubital Tunnel Syndrome
Kalpit N. Shah
What is cubital tunnel Compression of the ulnar nerve around

syndrome (CuTS)? the elbow
What is the most Between the two heads of the flexor
common site of carpi ulnaris and its aponeurosis
compression of the
ulnar nerve?
What are sites of Arcade of Struthers (hiatus in the
compression proximal to medial intermuscular septum)
the medial epicondyle? Medial intermuscular septum
Osborne’s fascia
What are sites of Anconeus epitrochlearis
compression distal to Osborne’s ligament (medial epicondyle
the medial epicondyle? to olecranon)
Fascial bands of FCU
Aponeurosis of FDS
What are common Paresthesias of the small finger, ulnar
symptoms of CuTS? half of the ring finger and ulnar dorsal
hand, weak hand intrinsic muscles
(continued)
K. N. Shah, MD
Department of Orthopaedic Surgery, Warren Alpert School of
Medicine, Brown University, Providence, RI, USA

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70 K. N. Shah
(continued)
What common hand Weakened grasp (intrinsic MCP
functions are weaker in flexors), weakened pinch (weak
patients with CuTS? adductor pollicis)
What is the Froment’s Due to weak adductor pollicis, the FPL
sign? fires to flex the thumb IP joint during
key pinch (tested with a piece of paper
in clinic)
Provocative tests for Tinel (tapping) sign at the elbow, elbow
CuTS? flexion >60s, direct pressure over elbow
What advanced testing Electromyography or nerve conduction
may be obtained to study
confirm the diagnosis?
Nonoperative options? Night splint with elbow at 45° flexion,
forearm in neutral rotation
Surgical options for In situ decompression, subcutaneous or
management of CuTS? submuscular transposition of the ulnar
nerve
What superficial nerve Medial antebrachial cutaneous nerve
is at risk of injury
during ulnar nerve
surgery?
Chapter 34
Other Compressive
Neuropathies
Ross Feller
What are the classically Entrapment occurs beneath the superior

described sites of transverse scapular ligament within
suprascapular nerve the suprascapular notch, whereas
entrapment and compression classically results from a
compression? posterior spinoglenoid notch cyst
How can one Atrophy and weakness will involve
differentiate between both the supraspinatus (abduction)
these two sites of and infraspinatus (external rotation)
compression with with entrapment of the nerve in the
physical examination? suprascapular notch, whereas only the
infraspinatus will be affected with more
distal compression of the suprascapular
nerve (i.e., isolated external rotation
weakness will result)
What nerve is affected Median nerve
in pronator syndrome?
(continued)
R. Feller, MD
The Warren Alpert Medical School of Brown University,
Providence, RI, USA
e-mail: rjfell.ross@gmail.com

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72 R. Feller
(continued)
What are the various Supracondylar process of the humerus,
sites of compression (5) ligament of Struthers, bicipital
in pronator syndrome? aponeurosis (lacertus fibrosus), between
ulnar and humeral heads of pronator
teres, FDS aponeurotic arch
What physical exam Tinel’s at the anterior forearm (not the
maneuvers can be wrist as with CTS)
employed to diagnosis
pronator syndrome?
Reproduction of symptoms with: (1)
resisted elbow flexion and supination
(compression at lacertus fibrosus), (2)
resisted forearm pronation with elbow
extended (compression between pronator
heads), and (3) resisted MF flexion
(compression at FDS fibrous arch)
What nerve is involved Posterior interosseous nerve (PIN)
in radial tunnel
syndrome?
What are the potential Fibrous bands anterior to radiocapitellar
sites of compression joint, leach of Henry (radial recurrent
in radial tunnel vessels), medial edge of ECRB, arcade
syndrome? of Frohse (proximal aponeurotic/
tendinous arch of supinator, most
common), distal edge of supinator
What nerve is affected Ulnar nerve at the level of the wrist/
in Guyon’s canal hand. Nerve is ulnar to artery
compression? Where
does the nerve lie in
relation to the artery?
What are the Transverse carpal ligament/hypothenar
boundaries of Guyon’s muscles (floor), volar carpal ligament
canal? (roof), pisiform/pisohamate ligament
(ulnar), hook of hamate (radial)
What are the zones of Zone I is proximal to bifurcation of ulnar
Guyon’s canal? nerve (mixed motor and sensory), zone II
surrounds deep motor branch, and zone
III surrounds superficial sensory branch
Chapter 35
Kienbock’s Disease
Devan Patel
What is the primary Avascular necrosis of the lunate

pathophysiology that leading to eventual collapse; seen
is thought to cause radiographically
Kienbock’s disease?
What are the stages of Stage I—Typically no radiographic
Kienbock’s disease seen findings, possibly fractures seen, and
radiographically? changes on MRI
Stage II—Sclerosis of the lunate
with possible fragmentation
Stage III—Fragmentation with
collapse
Stage IV—Degeneration of joint
surfaces surrounding the lunate
causing arthritis
(continued)
D. Patel, MD

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74 D. Patel
(continued)
What is the typical Dorsal wrist pain over the lunate
history of a patient with with a history of minor or repetitive
Kienbock’s disease? trauma
What is the natural history Progressive pain, decrease range of
of Kienbock’s disease? motion at the wrist, decreased grip
strength, progressive arthritis
What are surgical options Joint pinning, joint leveling,

to treat this disease? radial osteotomy, proximal row
carpectomy (PRC), joint fusions,
revascularization procedures, and
total wrist arthroplasty
What is the classic Ulnar negative variance
radiographic risk factor
for those with Kienbock’s
disease?
Chapter 36
De Quervain’s Tenosynovitis
Jeremy E. Raducha
Where is the location of pain in de Dorsoradial wrist

Quervain’s tenosynovitis?
Which wrist compartment is First dorsal compartment of
involved? the wrist
Which tendons run in this Extensor pollicis brevis and
compartment? abductor pollicis longus
(continued)
Wolfe SWM. Tendinopathy. In: Wolfe SWM, editor. Green’s operative

hand surgery. 7th ed. Philadelphia: Elsevier; 2017. p. 1904–24. https://
www-clinicalkey-com.revproxy.brown.edu/service/content/pdf/
watermarked/3-s2.0-B97814557742720 0 0563.pdf?locale=en_US.
Accessed 18 Apr 2017.
Ilyas AM, Ast M, Schaffer AA, Thoder JM. de Quervain Tenosynovitis
of the wrist. J Am Acad Orthop Surg. 2007;15(12):757–64. http://journals.
lww.com/jaaos/Abstract/2007/12000/de_Quervain_Tenosynovitis_of_
the_Wrist.9.aspx. Accessed 28 May 2017.
J. E. Raducha, MD

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76 J. E. Raducha
(continued)
What is the classical physical Finkelstein test or Eichhoff
exam maneuver that suggests de maneuver
Quervain’s if positive?
What are the nonoperative options Rest, NSAIDs, bracing,

for treatment? corticosteroid injection
What is the surgical option for Release of the first dorsal
treatment? compartment
Which nerve is most at risk during Superficial branch of the
surgical intervention? radial nerve
What is the common reason for Failure to decompress the
failed operative intervention? extensor pollicis brevis
subsheath
Chapter 37
Dupuytren’s Disease
Andrew Paul Harris
What cells play a primary role in Myofibroblasts

Dupuytren’s disease?
What two fingers are most Small and ring fingers
commonly involved with
What physical exam test can be Palm to table test
used to determine severity of
What type of enzyme may be Collagenase
injected to treat Dupuytren’s
disease?
Contracture of what tissue is the Fascia
cause of Dupuytren’s disease?
(continued)
A. P. Harris, MD
e-mail: andrew_harris@brown.edu

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78 A. P. Harris
(continued)
Fascial bands become cords in Pretendinous cord, spiral
Dupuytren’s disease. What cords cord, natatory cord,
may develop? retrovascular cord
The spiral cord causes the Centrally and superficial to

neurovascular bundle to displace in the A-1 pulley
what direction?
What is the most common surgical Fasciectomy
treatment for Dupuytren’s disease?
What is the most common Wound edge necrosis,
complication of Dupuytren’s hematoma formation
surgical excision?
In Dupuytren’s disease, the Garrod’s pads (knuckle
thickening of tissue on the dorsum pads)
of the PIP joints is known as what?
Chapter 38
Trigger Finger
Andrew Paul Harris
Adult trigger finger is most often A–1

associated with what flexor tendon
pulley?
Treatment of trigger finger Diabetics
with corticosteroid injection is
less effective in what patient
population?
What symptoms do patients with Pain over the A–1 pulley,
trigger finger often report? catching, locking of the
affected digit
Pediatric trigger finger may be A–1 pulley and also one
treated with surgical release of slip of the flexor digitorum
what structures? superficialis tendon
(continued)
A. P. Harris, MD

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80 A. P. Harris
(continued)
Proximal to the A–1 pulley, what Palmar aponeurosis pulley
other structure may contribute to (also known as Manske’s
trigger finger? pulley)
What is the medical term to Stenosing tenosynovitis

describe trigger finger?
What are some medical conditions Gout, rheumatoid arthritis,

that may contribute to trigger diabetes, trauma
finger?
What are two nonsurgical method Splinting, corticosteroid
of treating trigger finger? injection
What nerve is at risk for injury Radial digital nerve to the
during surgical release of the thumb
thumb A–1 pulley?
A thickened nodule on the flexor Notta’s node or nodule
tendon is known as what?
Chapter 39
Scaphoid Fractures
Andrew Paul Harris
What is the most common type of Waist fracture (middle

scaphoid fracture? third)
What direction is the blood flow to Retrograde
the scaphoid?
What scaphoid fracture is most Proximal pole scaphoid
prone to nonunion or avascular fracture
necrosis?
Nonunion of the scaphoid may Scaphoid nonunion
result in what chronic arthritic advanced collapse (SNAC
condition of the wrist? wrist)
Scaphoid fracture may be Lunate
associated with dislocation of what
carpal bone?
(continued)
A. P. Harris, MD

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82 A. P. Harris
(continued)
If a scaphoid fracture is suspected CT scan or MRI (more
but not seen on radiographs, what sensitive)
additional imaging tests can be
used?
What physical exam findings are Tenderness with palpation
associated with scaphoid fracture? of the snuff box and
scaphoid tubercle
What implants may be used to Headless compression
surgically treat scaphoid fractures? screws, scaphoid plate
What is the most common cause of Fall with hyperextension of
scaphoid fracture? the wrist
If a nonunion of a scaphoid is CT-scan
suspected after fixation, what
imaging test can be used to
confirm?
Chapter 40
Other Carpal Bone Fractures
Devan Patel
Which patients classically Those with trauma directly to the

get hook of the hamate hand such as baseball players,
fractures? hockey players, and golfers
Which tendons are closest to The fourth and fifth FDP tendons
the hook and can cause pain
when used?
What radiographic view Carpal tunnel view
is important to obtain
with hook of the hamate
fractures?
What is the most common Ulnar styloid impaction on the
fracture mechanism of the triquetrum during forceful wrist
triquetrum? extension
(continued)
D. Patel, MD

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84 D. Patel
(continued)
What is the most common Splint or cast immobilization
treatment for triquetrum
fractures?
Hypothenar tenderness can Pisiform
indicate a fracture of what
carpal bone?
What are the two types of Trapezial ridge fractures and
trapezium fractures? trapezial body fractures
What type of trapezium Trapezial body fractures due to
fracture is commonly seen in axial loading during a fall
cyclist?
Chapter 41
Lunate and Perilunate
Dislocations
Andrew Paul Harris
What emergency condition may Acute carpal tunnel

present with perilunate and lunate syndrome
dislocations requiring emergency
reduction and surgery?
How many stages are in the Four stages
Mayfield classification of
perilunate/lunate dislocation?
What three arcs may be injured Greater arc, lesser arc,
to cause perilunate or lunate tranlunate arc
dislocations?
What is the most common carpal Scaphoid (known as a
bone fracture associated with a transcaphoid perilunate
perilunate dislocation? dislocation)
(continued)
A. P. Harris, MD
Department of Orthopedic Surgery,
Providence, RI, USA

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86 A. P. Harris
(continued)
What carpal bone fractures may Radial styloid, scaphoid,
be associated with perilunate or capitate, triquetrum
lunate dislocations?
What is the first stage of lesser arc Scapholunate ligament
perilunate/lunate dislocation? disruption
What is the second stage of lesser Disruption of the
arc perilunate/lunate dislocation? capitolunate articulation
What is the third stage of lesser Disruption of the
arc perilunate/lunate dislocation lunotriquetral ligament
What is the fourth stage of injury Disruption of the short
required to produce a complete radiolunate ligaments
lunate dislocation? causing failure of the
radiolunate articulation
What radiograph is best used to Lateral wrist radiograph
diagnosis a perilunate or lunate
dislocation?
Chapter 42
First Metacarpal Base
Fracture
Travis Blood
What are the deforming Abductor pollicis longus, extensor

forces of the Bennett pollicis longus and adductor
fracture? pollicis—adduction and supination
What is the volar lip of the Volar oblique ligament
first metacarpal attached to
in a Bennett fracture?
What X-ray view is used Hyperpronated thumb view
to best visualize the first
metacarpal base fracture?
Does the Bennett or the Bennett fracture
Rolando fracture have a
better prognosis?
T. Blood, MD
Brown University Orthopedics, Brown University,
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_42
Chapter 43
Skier’s or Gamekeeper’s
Thumb
Steven F. DeFroda
What is a skier’s thumb? Acute injury to the thumb

metacarpophalangeal (MCP) joint
ulnar collateral ligament (UCL)
How does gamekeeper’s This is a chronic attenuation of
thumb differ? the UCL (as opposed to an acute
rupture)
What tendon can get Adductor pollicus aponeurosis
interposed in the ligament
tear?
What is the eponym for “Stener” lesion
an interposed adductor
tendon in a UCL injury?
(continued)

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90 S. F. DeFroda
(continued)
What are the operative >20° variation on varus/valgus stress
indications? >35° of opening at neutral, or 30° of
MCP flexion
What is the mechanism of Hyperextension and abduction at the
injury? MCP joint
What type of imaging can Stress radiographs of the MCP joint
aid in diagnosis? looking for widening
References
1. Schroeder NS, Goldfarb CA. Thumb ulnar collateral and radial
collateral ligament injuries. Clin Sports Med. 2015;34(1):117–26.
https://doi.org/10.1016/j.csm.2014.09.004.
Chapter 44
Boxer’s Fracture
Devan Patel
What are the most common Fourth and fifth metacarpals

metacarpals to have a
boxer’s fracture?
What is the most common Interossei muscles cause apex
deformity? What muscles dorsal deformity
cause this deformity?
What radiographs are True lateral radiographs are
commonly used to measure able to depict the sagittal plane
the deformity of these deformity
fractures?
Why are the fourth and Increased range of motion at the
fifth digits able to tolerate metacarpal phalangeal joint
increased angulation well?
(continued)
D. Patel, MD

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92 D. Patel
(continued)
What is the most common Stiffness and prominence in the
complication of conservative palm
treatment?
What are the operative Open fractures, unstable fractures,
indications for this type of volar angulation greater than
fracture? 10–50° depending on the digit,
significant rotational deformity
What are some surgical Dorsal plating, intramedullary
options for fixations? fixation, lag screw fixation, and
percutaneous pinning
Chapter 45
Phalangeal Fractures
Kalpit N. Shah
Which phalanx is Distal phalanx

the most commonly
fractured?
What deformity is Apex volar
created in proximal – Proximal fragment is flexed due to
phalanx fractures? Why? interossei
– Distal fragment is extended due to
central slip
What deformity is – Apex dorsal (if fracture is proximal
created in middle to FDS insertion)—central slip
phalanx fractures? Why? extends the proximal fragment and
FDS flexes the distal fragment
– Apex volar (if fracture is distal to
FDS insertion)—FDS flexes the
proximal fragment
(continued)
K. N. Shah, MD
of Medicine of Brown University, Providence, RI, USA

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94 K. N. Shah
(continued)
What are the operative Extra-articular, <10° angulation, and
indications for a 2 mm shortening
proximal or middle
phalanx fracture?
What are the operative Nail bed injury associated with a distal
indications for a distal phalanx fracture
phalanx fracture?
What is the most Stiffness of the affected digit
common complication of
phalangeal fractures?
Chapter 46
Finger (Phalangeal)
Dislocations
Tyler S. Pidgeon
Which proximal Dorsal

interphalangeal (PIP)
joint dislocation type is
most common?
What soft tissue The volar plate and at least one
structures are injured collateral ligament
during a dorsal PIP
joint dislocation?
What deformity results Swan neck deformity
from untreated dorsal
PIP joint dislocations?
What soft tissue The central slip and at least one
structures are injured collateral ligament
during a volar PIP joint
dislocation?
(continued)
T. S. Pidgeon, MD

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96 T. S. Pidgeon
(continued)
What deformity results Boutonniere deformity
from untreated volar
PIP joint dislocations?
How are dorsal PIP Closed reduction and buddy-taping
dislocations treated? for 3–6 weeks. To reduce apply volar-
directed force on the middle phalanx.
Hyperextension of the middle phalanx
prior to volar force may be required.
Pulling traction on the finger causes the
volar plate to block reduction. Open
reduction with volar plate extraction
may be required in irreducible
dislocations
How are volar PIP Closed reduction and extension
dislocations treated? splinting for 6–8 weeks
Describe the anatomy One proximal phalanx condyle
of a rotary PIP buttholes between the central slip and
dislocation. lateral band
How are rotatory PIP Closed reduction is attempted
dislocations reduced? with finger traction with
metacarpophalangeal and PIP joints at
90° of flexion to relax the lateral band.
However, open reduction is required in
most cases
How are dorsal distal Closed reduction and immobilization in
interphalangeal (DIP) slight flexion for 2 weeks via a dorsal
joint dislocations splint. Open reduction may be required
treated? if volar plate is interposed
Chapter 47
Metacarpal Fractures
Tyler S. Pidgeon
What are the No rotational deformity. No more than

acceptable parameters 2–5 mm of shortening. Maximum of
for nonoperative 10–20° of angulation at the index and
management of finger long fingers, 30° of angulation at the ring
metacarpal shaft finger, and 40° of angulation at the small
fractures? finger
Why does shaft There is greater carpometacarpal (CMC)
angulation joint range of motion at the small and
acceptability differ ring fingers compared to the middle and
between fingers? index fingers
What are indications Open fractures, intra-articular fractures,
for surgical rotational malalignment, displacement
management of finger as listed above, multiple metacarpal
metacarpal fractures? fractures, border digit fractures
(continued)
T. S. Pidgeon, MD

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98 T. S. Pidgeon
(continued)
How should hands In intrinsic plus position to tighten
with metacarpal the collateral ligaments of the
fractures be metacarpophalangeal (MCP) joint via
immobilized? the cam effect of the metacarpal head;
thus, preventing MCP stiffness
What are surgical Closed reduction and percutaneous
options of metacarpal pinning, open reduction and internal
shaft fractures? fixation (ORIF) with a plate, ORIF with
lag screws (minimum of two), tension
band wiring, cerclage/interosseous
wiring, external fixation, open
intramedullary fixation
What are the No rotational deformity. No more than
acceptable parameters 2–5 mm of shortening. Maximum of
for nonoperative 10–15° of angulation at the index and
management of finger long fingers, 30–40° of angulation at the
metacarpal neck ring finger, and 50–60° of angulation at
fractures? the small finger
Name and describe the The Jahss Technique: Flex the MCP joint
reduction technique to 90° and apply dorsally directed force
for metacarpal neck to the metacarpal head via the proximal
fractures. phalanx while stabilizing the metacarpal
shaft
Chapter 48
Traumatic/Revision Finger
Amputation
P. Kaveh Mansuripur
When feasible, what Healing by secondary intention

coverage technique (granulation)
provides the best 2-point
discrimination?
What kind of pain do Cold intolerance
patients most often
complain about?
The “composite graft” Children
technique works best in
which patients?
In general, what kind of Absorbable monofilament (gut,
suture should be used in chromic, etc.)
the fingertips?
A “V-Y” flap is useful in Transverse or dorsal oblique
what kind of tissue loss?
(continued)
P. Kaveh Mansuripur, MD
Hand and Upper Limb Surgery, Stanford University School
of Medicine, Stanford, CA, USA

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100 P. Kaveh Mansuripur
(continued)
What is the most common PIP flexion contracture
complication of the thenar
flap in adults?
The Moberg flap is used for The thumb
which digit?
What is the mechanism of a In amputations proximal to the
lumbrical plus finger? FDP insertion, attempt at finger
flexion will tension the lumbricals
and cause paradoxical extension
What are the major goals Cover bone, maintain length,
in treating traumatic digit maximize sensation, prevent
amputations? neuromas, maximize range of
motion and function
When revising a traumatic Cut digital nerves under tension so
amputation, how are that they retract
neuromas prevented?
Chapter 49
Tears of the TFCC
Avi DeLano Goodman
What are the Dorsal and volar radioulnar ligaments,

components of the central articular disc, meniscus homolog,
TFCC? ulnar collateral ligament, ECU subsheath,
ulnolunate and ulnotriquetral ligaments
Which areas are Periphery (10–40%), while central is
vascularized? avascular (similar to the meniscus)
What are the Ulnar-sided wrist pain, especially with
symptoms and turning a key (rotation), and ulnar or
physical exam radial deviation
findings?
What are the X-ray 3-view hand, 3-view wrist—usually
views needed to negative, but zero-rotation PA will show
evaluate? ulnar variance
(continued)
A. D. Goodman, MD

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102 A. D. Goodman
(continued)
Which is the best MR arthrogram, with sensitivity 84% and
imaging study for specificity 85%
TFCC evaluation?
What is the gold Wrist arthroscopy
standard for
diagnosis?
What are the Class 1—traumatic
classifications? Class 2—degenerative
(Subtypes describe location)
What are the surgical Arthroscopic debridement, repair, ulnar
options? shaft shortening, limited ulnar head
resection
Chapter 50
Carpal Instability
Avi DeLano Goodman
What are the broad Dissociative (within a carpal row or

classifications of intracarpal)
instability? Nondissociative (between carpal and
intercarpal rows) and combined (both)
What are the types DISI (from scapholunate tears → scaphoid
of dissociative flexes and lunate becomes dorsally
instability? angulated) and VISI (volar intercalated
segmental instability, from lunotriquetral
tears → lunate flexes with scaphoid and
becomes volarly angulated)
What is the Mayfield (I–IV)
classification of
perilunate injuries?
What are the X-ray Disruption of Gilula’s arcs
findings?
(continued)
A. D. Goodman, MD

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104 A. D. Goodman
(continued)
Clinically, what is Acute carpal tunnel syndrome
the acute concern
with perilunate
dissociation?
What is the Urgent reduction and fixation, with possible
surgical option carpal tunnel release
for perilunate
dissociation?
What are the Radial styloidectomy, denervation, proximal
surgical options for row carpectomy, partial or complete wrist
chronic instability? fusion
Chapter 51
Flexor Tendon Injuries
Andrew D. Sobel
Describe the flexor In the fingers

tendon “zones” Zone 1—distal to FDS insertion
Zone 2 (“no man’s land”)—distal
to distal palmar crease (A1 pulley),
proximal to FDS insertion
Zone 3—distal to carpal tunnel, proximal
to distal palmar crease (A1 pulley)
Zone 4—Within carpal tunnel
Zone 5—Wrist and forearm proximal to
carpal tunnel
In the thumb
Zone 1—Distal to interphalangeal joint (IP)
Zone 2—Distal to A1 pulley, proximal to IP
Zone 3—Thenar eminence
Zone 4–5—Same as fingers
(continued)
A. D. Sobel, MD

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106 A. D. Sobel
(continued)
Describe the flexor Five annular pulleys, three cruciate pulleys
pulley system prevent tendon bowstringing and direct
tendon gliding
Odd numbered pulleys (A1, A3, A5)
overlay joints (metacarpophalangeal,
proximal IP, distal IP) and arise from
volar plate of joints
Thumb has A1, Av, oblique, A2 pulleys
only
Which pulleys are Fingers—A2 and A4
the most important
Thumb—Oblique pulley
to prevent
flexor tendon
bowstringing in
the fingers? In the
thumb?
What is the Palm—FDP deep, FDS superficial
orientation of
Finger—FDP superficial, FDS deep
flexor digitorum
profundus FDS tendon splits at “campers chiasm”
(FDP) and and dives deep to insert on middle
flexor digitorum phalanx around FDP which continues
superficialis (FDS) distal to insert on distal phalanx
tendons in the palm
and digit and what
is the anatomic
landmark where
the orientation
changes?
What are the FDP—Flexion of distal IP joint
specific functions of
FDS—Flexion of proximal IP joint
the FDP and FDS
tendons?
51 Flexor Tendon Injuries 107
(continued)
What is the Diffusion through synovial fluid created by
predominate the tendon’s synovial sheath
way that tendons
receive nutrition?
When can flexor Laceration of <60% tendon width
tendon lacerations
be treated
nonoperatively?
What is the Number of suture strands crossing repair
most important site
determinant of
flexor tendon
laceration suture
repair strength?
Besides crossing Simple, running epitendinous suture
sutures, what can
be done to improve
gliding and strength
of a repaired
tendon?
How are chronic Two-stage reconstruction
flexor tendon
injuries typically Stage 1—Silicone rod placement
treated? Stage 2—Tendon graft interposition
Chapter 52
Extensor Tendon Injuries
Devan Patel
Which is the most Zone VI

frequently injured zone?
What is a zone I injury Injury at or distal to the DIP joint,
and what is the resulting causing a mallet finger deformity
deformity?
What is a zone III injury Disruption of the tendon over the
and what is the resulting proximal interphalangeal joint
deformity? causing a central slip injury and a
boutonniere deformity
What zone is a “fight bite” Zone V, over the metacarpal
injury and what is the phalangeal joint. Treatment is
treatment? typically irrigation and debridement
(continued)
D. Patel, MD

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110 D. Patel
(continued)
What is the Elson’s test The patient’s finger is position at 90°
and what does it indicate? at the PIP, typically over the corner
of a table. The patient is asked to
extend against resistance. Normal:
PIP extension with a flexible
DIP. Abnormal: No PIP extension,
with rigid DIP. Indicates central slip
injury
What is the classic Extension splitting
nonoperative treatment of
extensor injuries?
What are operative Tendon repair, tendon
options for extensor reconstruction, and tendon transfers
tendon injuries?
Nondisplaced distal radius Extensor pollicis longus rupture
fractures can result in
what extensor tendon
injury?
What is the typically EIP to EPL tendon transfer
treatment for an EPL
rupture?
Chapter 53
Nerve Injury
Ross Feller
Describe the relationship In the palm, the artery lies superficial

between the digital artery (volar) to the nerve, whereas at the
and nerve at the level level of the middle phalanx, this
of the (1) palm and (2) relationship is reversed
middle phalanx?
Name the different Epineurium, perineurium,
connective tissue layers endoneurium
of a nerve.
Describe the different Neuropraxia—No structural/anatomic
three main categories of change to the nerve, best prognosis;
nerve injury. Axonotmesis—Perineurium remains
intact but axons within a fascicle
rupture, prognosis based on degree of
scarring within the fiber; Neurotmesis—
Complete nerve rupture, requires repair
or reconstruction
(continued)
R. Feller, MD
Providence, RI, USA

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112 R. Feller
(continued)
What is the percentage The nerve can tolerated up to
of nerve stretch that 10% of stretch, with 15% leading
leads to neuropraxia and to neuropraxic injury and 20% or
axonotmesis? greater leading to axonotmesis
What is one reliable Water immersion testing: Presence of
method for determining wrinkling or puckering of the finger
digital nerve continuity within 4 min of submerging under
in the uncooperative water at 40 °C
child or the unconscious
patient?
What is the rate of One millimeter per day or 1 in. per
growth of a peripheral month
nerve following repair?
What is one way to Presence of an advancing Tinel’s sign
track recovery of an along the path of the injured nerve
axonotmetic nerve
injury using physical
examination?
What is the most Neuropraxia, therefore most low
common nerve injury energy gunshot wounds can be
resulting from low-energy managed with observation and not
gunshot wounds? What is acute exploration
the significance of this in
terms of treatment?
What are the available Epineural and grouped fascicular
techniques for direct repair. Epineural repair is used most
end-to-end nerve repair? commonly, with advocates believing
Which technique is that the additional intraneural
mostly used presently and damage involved in manipulating
what is the main reason individual fascicles can lead to more
proponents advocate for scarring and worse clinical results
this technique?
What other techniques Adhesives (e.g., Tisseel, Evicel, and
are available for nerve DuraSeal), conduits (e.g., Axogen,
repair other than direct vein graft), nerve grafts (autograft,
end-to-end suturing? allograft, or vascularized nerve graft),
end-to-side neurorraphy, nerve
transfers
53 Nerve Injury 113
(continued)
What is the “rule of 18”? The number of inches from the site of
nerve injury to the supplied muscle
plus the number of months from
injury should be less than 18 inch.
order for primary nerve repair to
be considered. The basis of this
principal lies in the fact that motor
end plates will become refractory to
reinnervation after about 18 months
in the adult patient
Chapter 54
Replantation
Steven F. DeFroda
What is the most important factor Mechanism of injury

when considering replantation?
What is the accepted warm <6 h proximal to carpus,
ischemia time for replantation? <12 h for digits
What is the accepted cold <12 h proximal to carpus,
ischemia time for replantation? <24 h for digits
How should an amputated digit Wrapped in saline moistened
be transported? gauze, in a sealed plastic bag,
on ice
What are the indications for • Thumb
replantation? • Through palm
• Multiple digits
• Wrist or proximal
• Any level in children
• Individual digits distal
to flexor digitorum
superficialis insertion
What is the generally accepted Bone, extensor tendon, artery,
order for the repair of structures vein, flexor tendon, nerve,
during replantation? skin (BEAVFTNS)
(continued)

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116 S. F. DeFroda
(continued)
What is the generally accepted Thumb, long, ring, small,
order for replantation of multiple index
digits?
In a multiple digit replantation, Structure-by-structure
is it preferred to repair digit-by-
digit or structure-by-structure?
References
1. Beris AE, Lykissas MG, Korompilias AV, Mitsionis GI, Vekris
MD, Kostas-Agnantis IP. Digit and hand replantation. Arch
Orthop Trauma Surg. 2010;130(9):1141–7. https://doi.org/10.1007/
s00402-009-1021-7.
Chapter 55
Rheumatoid Arthritis
and Other Inflammatory
Arthritides
Ross Feller
What is the classic Pencil-in-cup deformity

radiographic pattern of
arthropathy associated with
psoriatic arthritis?
What is arthritis mutilans Fulminant stage of osteolysis most
and what are the classic commonly observed in severe
findings associated with this psoriatic arthritis; osteolysis of all
disease? interphalangeal joints with digital
collapse/shortening resulting in
“opera glass hand”
What is the characteristic Joint subluxation resembling RA
radiographic appearance without radiographic articular or
of systemic lupus bony destruction
erythematosus (SLE)-
related arthropathy?
(continued)
R. Feller, MD
Providence, RI, USA

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118 R. Feller
(continued)
Define swan neck and Swan neck = PIP hyperextension,
boutonniere deformity? DIP flexion; Boutonniere = PIP
hyperflexion, DIP extension
What is the difference RA—MCP flexion and PIP
in deformity in RA vs. extension (swan neck deformity),
psoriatic arthritis? psoriatic arthritis—MCP
hyperextension, PIP flexion
(boutonniere)
What are the general Methotrexate and
guidelines for withholding hydroxychloroquine: do not
of the various withhold; Cyclophosphamide,
immunomodulating azathioprine, sulfasalazine: several
medications preoperatively? days; Leflunomide: 2 weeks;
DMARDs: two treatment cycles
What is the common Volar and ulnar subluxation
deformity affecting the MCP
joints in RA?
What are the options Passively correctable deformity
available for correction of addressed with tendon realignment
(1) passively correctable and and soft tissue reconstruction;
(2) fixed MCP deformity fixed deformity addressed with
related to RA? arthroplasty
What is caput ulna? Chronic DRUJ involvement
leads to destruction and dorsal
subluxation of the ulna resulting
in dorsal prominence, mechanical
irritation of extensor tendons, and
possible rupture
What the treatment options Single—End to end repair, suture
for single (small finger) and to adjacent tendon, graft; Double—
double extensor tendon Suture ring finger stump to intact
(ring and small finger) middle finger extensor tendon, EIP
rupture in RA? transfer to small finger
Chapter 56
Degenerative Arthritis
of the Hand and Wrist
Ross Feller
What is the ideal position of 10–20° flexion, 20 pronation,

fusion of the thumb MCP? 20° abduction
What is the ideal position of Index finger 20–25 flexion,
fusion of the PIPJs? middle finger 30 flexion, ring
finger 40 flexion, small finger
40–45 flexion
What is the ideal position of Neutral to slight flexion
fusion of the DIPJs?
What are the initial radiographic Beaking of the radial styloid
changes of SLAC wrist? with eventual radioscaphoid
arthritis
What are the stages of SNAC? I-radial styloid,
radioscaphoid OA;
II-scaphocapitate OA; III-
periscaphoid OA
(continued)
R. Feller, MD
Providence, RI, USA

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120 R. Feller
(continued)
What is the key factor guiding Status of the capitate
the decision between performing and lunate facet articular
proximal row carpectomy (PRC) cartilage
versus four-corner arthrodesis
(FCA) in the setting of SLAC
wrist?
What staging system is commonly Eaton staging
used in thumb CMC OA?
What is the classic deformity Metacarpal adduction with
associated with end-stage thumb MCP hyperextension
CMC OA?
What surgical treatment options Sauve-Kapandji, Darrach,
are available for management of ulnar hemiresection
DRUJ OA? arthroplasty, implant
arthroplasty
Chapter 57
Complex Regional Pain
Syndrome
Ross Feller
What are the main Swelling, pain, hyperesthesia/allodynia,

symptoms of CRPS? sensory abnormalities, skin changes
What are the modalities Radiography (showing
available for diagnosis demineralization of the limb),
of CRPS other than triple phase bone scan, quantitative
history and physical sweat test versus the contralateral
examination? limb, thermography, and diagnostic
sympathetic nerve block
What changes occur There is a transition from “warm
in the transition to the CRPS,” which is dominated by
chronic form of CRPS? inflammatory symptoms, to “cold
CRPS,” characterized by autonomic
dysfunction, atrophy, contractures,
dystonia, hair/nail changes
(continued)
R. Feller, MD
Providence, RI, USA

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122 R. Feller
(continued)
What has been shown Vitamin C
in some studies to
decrease rates of CRPS
following distal radius
fracture?
What are other Bisphosphonates, calcitonin,
available treatment occupational therapy (graded motor
options for CRPS? imagery and mirror therapy), oral
steroids, acupuncture, spinal cord
stimulation, sympathectomy, and in
some severe cases, amputation
Chapter 58
Hand Infections
Ross Feller
What is the definition A paronychia is an infection between the

of paronychia and nail plate and eponychial fold. A felon is
felon? a suppurative infection of the pulp of the
distal phalanx of a finger or thumb
What is the most Pasteurella multocida (cat bite) and
common organism Eikenella corrodens (human bite)
responsible for
infection following a
cat bite and a human
bite?
What is Parona’s The potential space of the volar distal
space? forearm between the pronator quadratus
and the sheath of the FDP tendons. It is
in continuity with the midpalmar space
What are the three Thenar, midpalmar, and hypothenar
deep spaces of the
hand?
(continued)
R. Feller, MD
Providence, RI, USA

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124 R. Feller
(continued)
What structures Midpalmar oblique septum (runs from
divide the thenar palmar fascia to third metacarpal
and midpalmar, shaft) and hypothenar septum (palmar
and midpalmar and aponeurosis to fifth metacarpal shaft)
hypothenar spaces?
What is a collar An abscess of the interdigital web space.
button abscess? What Fingers are held in an abducted position
is the classic position
of the fingers with a
collar button abscess?
What are Kanavel’s Four signs associated with the clinical
signs? diagnosis of flexor tenosynovitis: (1)
finger held in flexed posture, (2) fusiform
swelling of the digit, (3) tenderness along
the flexor sheath, (4) pain with passive
extension of the finger
What are the signs Innocuous appearing or cellulitic
and symptoms of with extreme tenderness (pain out
necrotizing fasciitis? of proportion) in early stages, with
progression to bullae formation, soft
tissue crepitus, hyper/anesthesia, and
frank soft tissue necrosis accompanied by
systemic sepsis as disease progresses
What are the most Type I-mixed anaerobic/aerobic including
common organisms non-group A strep
implicated in Type II-Group A strep
necrotizing fasciitis?
What is the organism Clostridium species
responsible for gas
gangrene?
Part III
The Lower Extremity
Chapter 59
External Snapping Hip
John R. Tuttle
What anatomic structures are involved Iliotibial band snapping

in external snapping hip? over greater trochanter
Is external snapping hip usually painful? No
Are radiographic and MRI findings Yes
typically normal in this condition?
What test helps diagnose a tight tensor Ober’s test
fascia lata?
Is nonoperative treatment successful in Yes
most cases?
What is the surgical treatment for IT band lengthening (or
painful external snapping hip that fails windowing)
nonoperative treatment?
What is a potential risk specific to this Trendelenburg gait
operation?
J. R. Tuttle, MD, MS
Sports Medicine, Department of Orthopaedic Surgery, Virginia
Tech Carilion School of Medicine, Roanoke, VA, USA
e-mail: jrtuttle@carilionclinic.org

https://doi.org/10.1007/978-3-319-78387-1_59
128 J. R. Tuttle
Bibliography

1. Lewis CL. Extra-articular snapping hip: a literature
review. Sports Health. 2010;2(3):186–90. https://doi.
org/10.1177/1941738109357298.
Chapter 60
Fractures of the Proximal
Femur
Viorel Raducan
What is the most common Fall from a standing height

mechanism of injury for
fractures of the proximal femur
in the elderly?
What is the most common Osteoporosis
predisposing factor for
fractures of the proximal
femur?
What is the typical clinical Shortening/external rotation and
finding in fractures of the abduction
proximal femur?
What are the most common Nonunion and osteonecrosis
orthopedic complications of
fractures of the femoral neck?
(continued)
V. Raducan, MD, FRCS(C)

Department of Orthopaedic Surgery, Marshall University School of
Medicine, Huntington, WV, USA
e-mail: raducan@marshall.edu

https://doi.org/10.1007/978-3-319-78387-1_60
130 V. Raducan
(continued)
What is the preferred Surgery
treatment for fractures of the
proximal femur?
What is the major benefit of Decreased mortality at 1 year

surgical treatment in fractures after fracture
of the proximal femur?
What is the most useful X-rays—hip (AP/lateral), pelvis
imaging study for fractures of (AP), full length femur (AP/
the proximal femur? lateral)
What is the prerequisite for Optimization of the medical
optimal outcome of surgery for status and timing (within 48 h of
proximal femur fractures? injury)
What are the most common Internal fixation (if undisplaced)
methods of surgical treatment and arthroplasty (if displaced)
for fractures of the femoral
neck?
What is a stable Absence of fracture in the lesser
intertrochanteric fracture? trochanter (the calcar)
What is an unstable Presence of fracture of the
intertrochanteric fracture? calcar and/or reverse obliquity
fracture line (proximal medial to
distal and lateral)
What is the method of Dynamic hip screw or
treatment for stable cephalomedullary nail (equal
intertrochanteric fractures? results)
What is the preferred method Cephalomedullary nail (prevents
of treatment for unstable shortening and varus malunions)
intertrochanteric fractures?
What is the most common Screw cutout
complication in surgical
treatment of intertrochanteric
fracture?
What are the predictors of Male sex, age over 85, delay
increased mortality after of surgery (>48 h), > 2
surgery for proximal femur comorbidities, ASA III–IV,
fracture in the elderly? intertrochanteric pattern
60 Fractures of the Proximal Femur 131
(continued)
What is the position of VARUS ± shortening ± external
malunions in proximal femur rotation
fractures?
What are the characteristics of Low energy/transverse/no
atypical femur fractures? comminution/incomplete/
biphosphosphonate use
What is the most sensitive/ MRI scan
specific imaging study for
the diagnosis of undisplaced
fractures of the proximal femur
with negative X-rays?
What is a subtrochanteric Fracture of the proximal femur
fracture? below the lesser trochanter
(with possible proximal/distal
extension)
What is the treatment of Surgery—internal fixation.
subtrochanteric fractures? Exception—contraindication
general/regional anesthesia
Chapter 61
Native Hip Dislocations
Viorel Raducan
What is the incidence Hip dislocations are rare injuries

of hip dislocations?
What are the most High energy trauma in young patients
potent characteristics with 95% incidence of associated injuries
of hip dislocations?
How are hip Position of the head in relationship with
dislocations classified? the acetabulum (anterior/posterior)
and presence of associated injuries
(complex—with associated injuries,
simple—no associated injuries)
What is the incidence 90.0%
of posterior hip
dislocations?
(continued)


https://doi.org/10.1007/978-3-319-78387-1_61
134 V. Raducan
(continued)
What is the Dashboard injury (impact on the knee
mechanism of with the hip adducted and internally
posterior hip rotated)
dislocation?
What are the Fractures of the posterior wall of the
associated injuries acetabulum, femoral head and neck,
in posterior hip injury to the sciatic nerve, fractures
dislocations? around the knee (25%)
What is the clinical Leg shortened, hip flexed, adducted, and
presentation in internally rotated
posterior?
What is the EMERGENT REDUCTION—within
determinant 6 h of injury/presentation
prognostic factor
in treatment of hip
dislocation?
What are the imaging X-rays—AP pelvis and CT scan
studies?
What are the Postreduction, complex dislocations
indications for
CT scan in hip
dislocations?
What is the Impact on the leg in abduction
mechanism of anterior
hip dislocations?
What is the SUPERIOR (impact on the leg
classification in abduction and extension) and
of anterior hip INFERIOR (obturator)—impact on
dislocation? the leg in hip flexion, abduction, and
external rotation
What are the Irreducible dislocation, nonconcentric
indications of open reduction, intra-articular body, complex
reduction in hip dislocations
dislocation?
61 Native Hip Dislocations 135
(continued)
What are the Femoral head impaction and chondral
associated injuries injuries
in anterior hip
dislocations?
What are the Osteonecrosis of the femoral head
complications of hip (5–40%), posttraumatic arthritis (20%),
dislocations? sciatic nerve palsy (8–20%), recurrent
dislocation (<2%)
How can hip The position of the hip (internal
dislocations be rotation—POSTERIOR, external
differentiated rotation—ANTERIOR)
clinically?
Chapter 62
Hip Osteoarthritis
Stephen Marcaccio
Define osteoarthritis. A pathologic, non-reversible condition

characterized by destruction of
articular cartilage
Describe a physical Overweight body habitus, potential
exam for a patient with leg length discrepancy, lack of full
hip OA. extension or flexion in passive ROM,
catching/clicking
Name four radiographic 1. Subchondral cysts
findings with OA. 2. Subchondral sclerosis
3. Osteophyte formation
4. Joint space narrowing
What is the conservative Physical therapy, scheduled anti-
treatment for hip OA? inflammatories, weight loss
(continued)
S. Marcaccio, MD
Department of Orthopaedic Surgery, Rhode Island Hospital,
e-mail: stephen_marcaccio@brown.edu

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138 S. Marcaccio
(continued)
What is the eponym Smith-Petersen
for the direct anterior
approach to the hip?
What is the eponym for Southern/Moore
the posterior approach
to the hip?
What is the interval Superficial: TFL/Sartorius
for the direct anterior Deep: Rectus femoris/gluteus medius
What is a major danger Lateral femoral cutaneous nerve
in the direct anterior
What is a major danger Sciatic nerve
in the direct posterior
What is the classic Flexion, adduction, and internal
position of posterior hip rotation
dislocations?
What is the classic Extension, abduction, and external
position for anterior rotation
dislocation of the hip?
Chapter 63
Osteonecrosis
Stephen Marcaccio
Define avascular An orthopedic phenomenon

necrosis. characterized by decreased vascular
perfusion to the bones supporting the
hip joint resulting in bone destruction
and joint breakdown
List three direct causes 1. Irradiation
of AVN. 2. Trauma
3. Hematologic disease (leukemia)
List three indirect 1. Alcoholism
causes of AVN. 2. Hypercoaguable state
3. Chronic steroid use
4. Idiopathic
(continued)
S. Marcaccio, MD

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140 S. Marcaccio
(continued)
What is the name The Steinberg Classification (modified
of the classification Ficat)
system for AVN?
What is the most MRI
sensitive and specific
imaging test for
detecting AVN?
What is the most Bisphosphonates
common method
of conservative
management for
AVN?
List three operative 1. Core decompression with bone
interventions for grafting
management of AVN. 2. Rotational osteotomy
3. Total hip resurfacing
Chapter 64
Total Hip Arthroplasty
Nicholas Lemme and Alexandre Boulos
What are the four most Posterior/posterolateral; direct

popular surgical approaches lateral, anterolateral, direct anterior
to the hip?
What are the four 1. Acetabular shell
components that make up a 2. Acetabular lining
total hip arthroplasty? 3. Femoral head
4. Distal stem
(continued)
N. Lemme, MD (*) · A. Boulos, MD

Department of Orthopaedics, Brown University, Providence,
RI, USA
e-mail: nicholas_lemme@brown.edu; alexandre_boulos@brown.edu

https://doi.org/10.1007/978-3-319-78387-1_64
142 N. Lemme and A. Boulos
(continued)
What are the intervals for Gluteus maximus (inferior gluteal
the posterior/posterolateral nerve) and gluteus medius/tensor
approach to the hip and fascia lata (superior gluteal nerve)
what are the structures at Structures at risk are sciatic nerve,
risk? inferior gluteal artery, and medial
femoral circumflex artery
What are the superficial Superficial: Sartorius (femoral
and deep intervals for the nerve) and tensor fasciae lata
direct anterior approach to (superior gluteal nerve)
the hip and what are the Deep: Gluteus medius (superior
structures at risk? gluteal nerve) and rectus femoris
(femoral nerve)
Structures at risk: Lateral femoral
cutaneous nerve, ascending branch
of lateral femoral circumflex
What is the recommended 30–50° Abduction and 5–25°
placement of the cup in the anteversion
acetabulum?
What are the two methods 1. Cement fixation
of prosthetic fixation for a (polymethylmethacrylate)
THA? 2. Bone in-growth fixation (porous)
What is the classification Vancouver classification
system used for post-op
periprosthetic femur
fractures?
What is the most common Peroneal branch of sciatic nerve,
nerve injury seen in THA? because it is closest to the
acetabulum
What are the common 1. Placing a femoral component that
causes of intraoperative is too large
periprosthetic femur 2. Aggressive rasping during bone
fractures? preparation
3. Rapid impaction of femoral
component
What are risk factors 1. Poor bone quality
for post-operative 2. Cementless prostheses
periprosthetic femur 3. Compromised bone stock
fractures? 4. History of revisions
64 Total Hip Arthroplasty 143
What is the most common 75–90% occur posteriorly

direction of hip dislocation
following THA?
Which hip positions put one Hip flexion and internal rotation
at most risk for a posterior
dislocation following a
posterior approach?
Which hip positions put one Hip extension and external rotation
at most risk for an anterior
dislocation following an
anterior approach?
What are the surgical- 1. Soft tissue tension
related factors that increase 2. Component position
the risk of dislocation 3. Impingement
following THA? 4. Head size
5. Acetabular lining profile
What can be done to 1 time dose of radiation or
prevent heterotopic indomethacin
ossification in a predisposed
patient?
How can a periprosthetic Replace implant with longer stem
femur fracture with an that passes the fracture site
unstable implant be
treated?
Why is it important for a 1. Allows for balancing of soft tissue
surgeon to replicate the resulting in improved hip stability
offset when performing a 2. Prevents leg length discrepancies
THA?
Which is the safest zone Posterior-superior zone
for the placement of Structures: superior gluteal
acetabular screws and what nerve/vessels and the sciatic
neurovascular structures are nerve
at risk in this zone?
Chapter 65
Femoral Shaft Fractures
James Levins
When evaluating and treating Ipsilateral femoral neck

a high-energy femoral shaft fracture (up to 9%
fracture, what other type of co-incidence with shaft
femur fracture in the ipsilateral fractures, obtain a CT scan
leg must you have a high with fine cuts through the
suspicion for? femoral neck) [1]
What four aspects of the Length, rotation, femoral neck
operative extremity do you need (for fracture), knee exam for
to check after fixing a femoral ligamentous injury
shaft fracture?
How much blood can potentially 1–1.5 L
be lost in the thigh from a
femoral shaft fracture?
(continued)
J. Levins, MD
Orthopaedic Surgery, Brown University, Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_65
146 J. Levins
(continued)
In a mid-shaft femur fracture, Varus—from the gluteal
what position does the proximal muscles and external rotators
femoral segment usually rest which abduct the proximal
relative to the distal segment, segment (the adductor mass
and why? will translate the distal
segment medially)
Flexed—from the
psoas which flexes the
proximal segment (the
gastrocnemius inserts
above knee on posterior
femoral condyles and
extends the distal segment
relative to the proximal)
What two approaches may be Anterograde (piriformis—or
used for intramedullary nailing trochanteric-entry nail) or
of a femoral shaft fracture? retrograde
Is there a difference in union No
rate between anterograde and
retrograde nailing of a mid-shaft
femur fracture?
If placing a tibial traction pin for Laterally, to avoid injury to
a femur fracture, which side of the common peroneal nerve
the tibia should you start your
incision and why?
In an unstable poly-traumatized To avoid further hypotension
patient who is taken emergently by minimizing time under
to the OR with neurosurgery for anesthesia, limiting blood loss
a closed head injury and noted and lowering the risk of fat
to have a femoral shaft fracture, emboli, i.e., damage control
why would it be prudent to orthopedics
perform external fixation instead
of intramedullary nailing?
Reference
1. Tornetta P, Kin MSH, Creevy WR. Diagnosis of femoral neck
fractures in patients with a femoral shaft fracture. J Bone Joint
Surg. 2007;89A:39–43.
Chapter 66
Ligamentous Knee Injury
James Levins
Classically, what injuries compose the Anterior cruciate

“unhappy triad” or “terrible triad” ligament (ACL), medial
injury to the knee? collateral ligament
(MCL), medial meniscus
injury
Which meniscus (medial or lateral) is Lateral meniscus
commonly injured in an acute ACL
rupture?
What is the reason for the limited Intra-articular structures
healing potential of the cruciate have poor blood supply
ligaments relative to the collateral relative to the rich
ligaments? extra-articular supply
What motion does the ACL primarily Anterior tibial
prevent? translation
(continued)
J. Levins, MD
Department of Orthopaedic Surgery, Brown University, Providence,
RI, USA

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148 J. Levins
(continued)
What knee injury is commonly seen Posterior cruciate
in a dashboard-type injury where a ligament (PCL) tear
patient sustains a posterior acetabular
wall fracture?
When performing ACL reconstruction, Vertically oriented ACL
what technical error is associated with graft, often resulting
early ACL failure? from a femoral tunnel
placed too anteriorly
A patient has a multi-ligamentous Pulse exam, ankle-
knee injury after a motorcycle accident, brachial index (ABI),
suspicious for a knee dislocation that CT angiogram if ABI
was reduced in the field. What studies <0.9 (due to the risk of
would you want to obtain urgently? popliteal artery injury)
Chapter 67
Meniscal Tear
Jonathan Hodax
What are the three Central: The “white-white,” or avascular

zones of the meniscus? zone
Middle: The “red-white,” or partially
vascularized zone
Peripheral: The “red-red,” or
vascularized zone
What meniscus tears Only those in the vascular zones of the
can be repaired? meniscus (peripheral tears)
What is the “gold Vertical mattress sutures in an “inside
standard” technique for out” technique (meaning the suture
meniscal repair? needle is passed from within the joint to
outside the joint)
(continued)
J. Hodax, MD, MS
Providence, RI, USA

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150 J. Hodax
(continued)
In what population is Older patients with degenerative tears
the medial meniscus
more likely to be
injured?
In what population is Younger patients with an acute injury,
the lateral meniscus especially together with an ACL tear
more likely to be
injured?
What is the effect of Increased joint contact pressure,
removing or debriding decreased joint stability, and an overall
some or all of the faster progression to arthritis
meniscus?
Chapter 68
Extensor Mechanism Injuries
of the Knee
Jonathan Hodax
What are the components of the The quadriceps, the

extensor mechanism? quadriceps tendon, the
patella, the patellar tendon,
and the tibial tubercle
In what age group are each of Tibial tubercle: Patients
the components of the extensor with open physes (pediatric
mechanism injured? patients)
Patellar tendon: Patients
<40 years old
Patellar tendon: Patients
<40 years old
Quad tendon: Patients
>40 years old
Patellar fractures: Any
age
(continued)
J. Hodax, MD, MS
Providence, RI, USA

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152 J. Hodax
(continued)
What physical exam finding Inability to straight leg
is an indication for operative raise, or an “extensor lag”
management in suspected quad of 30°
tendon rupture, patellar tendon
rupture, or patellar fracture?
What allows some patients with An intact medial and
complete transverse patella lateral retinaculum
fractures to still perform a straight
leg raise?
What kind of suture is typically used A running locking stitch,
on the quad tendon and the patellar typically a “Krackow”
tendon to prevent suture cut-out?
What are the ways tendon can be Suture can be passed
repaired back to the patella? through bone tunnels and
tied or can be fixed to the
bone using suture anchors
Chapter 69
Lower Extremity Tibia
and Fibula Shaft Fractures
Tyler S. Pidgeon
When treated with Less than 10° of flexion/extension

closed reduction, what and 5° of varus/valgus. There should
are the acceptable be 50% cortical apposition, less than
parameters for 1 cm of shortening, and less than 10° of
angulation in the rotational malalignment
sagittal and coronal
planes as well as
rotation and length in
tibia shaft fractures?
Proximal third Procurvatum (apex anterior) and
tibia shaft fractures valgus
classically fall into
what deformity during
intramedullary nailing?
(continued)
T. S. Pidgeon, MD

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154 T. S. Pidgeon
(continued)
To avoid deformity Blocking screws (posterior and lateral
during intramedullary to avoid procurvatum and valgus,
nailing of proximal third respectively), unicortical plating,
tibia shaft fractures, and semi-extended or suprapatellar
name three techniques approaches
that may be used.
What is the most Anterior knee pain (>50% of cases)
common complication
of intramedullary
nailing of tibia shaft
fractures?
Describe the Gustilo- Type I: Wound <1 cm; minimal
Anderson classification periosteal stripping. Type II: Wound
for open tibia fractures. 1–10 cm; mild to moderate periosteal
stripping. Type III A: Wound >10 cm;
substantial periosteal stripping and soft
tissue injury; no flap required. Type III
B: Substantial periosteal stripping and
soft tissue injury; flap required due to
inadequate soft tissue coverage. Type
III C: Substantial soft tissue injury with
vascular injury requiring repair
In open tibia fractures Early administration of antibiotics
what is the most
important intervention
in reducing infection?
According to the LEAP Severity of soft tissue injury
study, what is the most
critical predictor for
amputation in open
tibia fractures?
In patients with tibia Compartment pressure monitoring
fractures, what is demonstrating a compartment pressure
the most sensitive within 30 mmHg of the patient’s pre-
diagnostic test (other operative diastolic blood pressure
than physical exam)
for the diagnosis
of compartment
syndrome?
69 Lower Extremity Tibia and Fibula Shaft Fractures 155
What are the Decreased time to union and decreased

advantages of time to weight bearing
intramedullary nailing
compared to closed
reduction and casting of
tibia shaft fractures?
How does the time to Time to union is equivalent between
union compare between these methods
treatment of tibia
shaft fractures with
intramedullary nailing
vs. plating?
Chapter 70
Distal Femoral Fractures
Viorel Raducan
What is the definition of a Fractures in the area 5 cm’s

distal femoral fracture? proximal to the distal femoral joint
line
What is the age distribution Bimodal—young and elderly
of distal femoral fractures?
What is the mechanism High energy trauma
of injury of distal femoral
fractures in the young
population?
What is the mechanism Low energy trauma—fall from
of injury in the elderly standing height
population?
How are distal femoral Extraarticular/intraarticular/
fractures classified? periprosthetic
(continued)


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158 V. Raducan
(continued)
What is the typical Extension (gastrocnemius),
displacement of distal shortening (hamstrings), and varum
femoral fractures (adductors)
What structure is at risk in Popliteal artery—emphasis on
(displaced) distal femoral vascular exam, presence of distal
fractures and all injuries pulses
around the knee?
What is the imaging study X-rays—knee (AP/lateral/obliques),
of choice for fractures of full length femur
the distal femur?
What is a Hoffa fracture? Fracture of the lateral condyle of
the femur in the coronal plane
What is the indication for Intraarticular extension,
CT scan in distal femur preoperative planning
fractures?
What is the indication Absence of distal pulses especially
for angiography in distal if no recovery after limb alignment
femoral fractures? (in line traction)
What is the preferred Surgery—open reduction and
treatment for distal femoral internal fixation
fractures?
When can nonoperative Prohibitive surgical risk. Relative
treatment be considered indication—non displaced fractures
in fractures of the distal
femur?
What are the implants Fixed angle devices and retrograde
of choice for the surgical intramedullary nails
treatment of distal femoral
fractures?
What are the goals of Re-establish the anatomical knee
surgery in distal femoral axis and an anatomical joint
fractures? line with stable internal fixation
allowing early active range of
motion
What are the complications Malunion, varum nonunion (19%),
after treatment of distal and symptomatic hardware
femoral fractures?
Chapter 71
Patellar Fractures
Brian H. Cohen
What is the extensor Quadriceps muscle, quadriceps tendon,

mechanism of the knee medial and lateral retinaculum,
made up of? What patellofemoral and patellotibial
function does the ligaments, patella, patellar tendon and
extensor mechanism tibial tubercle, extension of the knee
have?
What are the two main Lateral and medial facets, a vertical
facets of the patella? ridge divides the larger lateral facet
Which is larger? What (about 2/3 the area) from the smaller
is unique about the medial facet, the patella has the thickest
articular cartilage? articular cartilage in the body
What is the blood The geniculate arteries from an
supply to the patella? extraosseous arterial ring which also
give the intraosseous blood supply
(continued)
B. H. Cohen, MD

https://doi.org/10.1007/978-3-319-78387-1_71
160 B. H. Cohen
(continued)
What is the mechanism Usually, a direct blow or fall onto
of injury? patella or indirect eccentric contraction,
more common in patient <40 years
old (Quadtriceps tendon tears more
common in patients >40 years old)
What physical exam Knee extension of the knee. Straight leg
finding should you raise test. If able to extend knee, then
test? If intact what the patellar retinaculum is intact
could be the reason for
this?
If there is a large Arthrocentesis with aspiration of the
hemarthrosis and it hemarthrosis and injection of lidocaine,
is difficult to exam then reexamine the knee for extension
patient due to pain
what can you do?
What can be mistaken A bipartite patella which is a failure of
for a patella fracture ossification centers to fuse. It commonly
on X-ray? What is bilateral (50%) and is located in
it? Where is it most the superior lateral quadrant of the
commonly located? patella
What are the types of Transverse, pole (superior and inferior)
patella fractures? or sleeve (inferior pole in childern),
vertical, marginal, osteochondral,
comminuted (stellate)
What are indications Intact extensor mechanism (able to
for nonoperative straight leg raise), nondisplaced or
treatment? What is the minimally displaced fractures, vertical
treatment? fracture, early weight bearing in
extension in cylinder cast or locked
hinged knee brace, begin early in range
of motion in 2–3 weeks
What are surgical Open fractures, intraarticular step off of
indications for patella 2 mm or more, and the inability of the
fractures? patient to extend knee actively
What are some surgical Tension-band wiring, lag screw fixation,
options of fixation? cerclage, cannulated lag screw with
tension band, partial patellectomy, and
total patellectomy
Chapter 72
Knee Tendon Rupture
(Patellar and Quadriceps
Tendons)
John R. Tuttle
What age and gender is Males younger than 40

most likely to be affected by
patellar tendon rupture?
What exam finding would Loss of active knee extension or
you expect with a complete extensor lag
patellar tendon rupture?
What radiographic findings Patella alta, MRI
might you expect and what
imaging modality is the most
sensitive to confirm the
diagnosis?
What is the preferred Primary repair
treatment for acute, complete
patellar tendon tears?
(continued)

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162 J. R. Tuttle
(continued)
What do you do if the tendon Auto or allograft tendon
is not repairable? reconstruction
What age and gender is Males over 40
more likely to be affected by
quadriceps tendon rupture?
What are some risk factors Renal failure, diabetes, RA,
for quad tendon rupture? hyperparathyroidism, connective
tissue disorders, steroids, cortisone
injections
What radiographic finding Patella baja
would you expect with quad
tendon rupture?
What is the preferred Primary repair, chronic injuries
treatment for acute or may require tendon lengthening
chronic quad tendon rupture? (V-Y) or graft augmentation
What are some common Knee stiffness, strength deficit
complications following quad (nearly half of patients), inability
tendon repair? to return to sports (about half of
patients)
Bibliography
1. Brooks P. Extensor mechanism ruptures. Orthopedics. 2009;32(9).
Chapter 73
Patellar Dislocation
Steven F. DeFroda
What ligament is often Medial patellafemoral ligament

injured in patellar (MPFL) [2]
dislocation?
What are risk Hyperlaxity
factors for patellar Trochlear dysplasia
dislocation? [1] Lateral condyle hypoplasia
High Q angle
Prior instability event
Excessive lateral patellar tilt
Increased femoral anteversion
Genu valgum
External tibial torsion
What is “miserable Combination of genu valgum, excessive
malalignment femoral anteversion, and external tibial
syndrome”? torsion. All contribute to high Q angle
(continued)

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164 S. F. DeFroda
(continued)
What type of bony Avulsion fracture of medial patellar
injury is associated facet and/or impaction fracture of
with patellar lateral femoral condyle [2]
dislocation?
What is the best way to Sunrise view radiograph
assess patellar tilt?
What is the TT-TG Distance between lines drawn
distance? perpendicular to posterior tibial cortex
at the level of the tibial tubercle and
trochlear groove on axial CT/MRI cuts
What is an abnormal Greater than 15–20 mm
TT-TG distance?
References
1. Khan N, Fithian D, Nomura E. In: Sanchis-Alfonso V, editor.
Anterior knee pain and patellar Inestability. London: Springer;
2011. https://doi.org/10.1007/978-0-85729-507-1.
2. DeFroda SF, Hodax JD, Cruz AI. Patellar instability. J Pediatr.
2016;173:258–258.e1. https://doi.org/10.1016/j.jpeds.2016.03.025.
3. Waterman BR, Belmont PJ, Owens BD. Patellar dislocation in
the United States: role of sex, age, race, and athletic participation.
J Knee Surg. http://www.ncbi.nlm.nih.gov/pubmed/22624248.
Published 2012. Accessed 27 Nov. 2015.
4. Fithian DC. Epidemiology and natural history of acute patellar
dislocation. Am J Sports Med. 2004;32(5):1114–21. https://doi.
org/10.1177/0363546503260788.
5. Chotel F, Bérard J, Raux S. Patellar instability in children and
adolescents. Orthop Traumatol Surg Res. 2014;100(1 S):S125–37.
https://doi.org/10.1016/j.otsr.2013.06.014.
Chapter 74
Total Knee Arthroplasty
Alexandre Boulos and Nicholas Lemme
Describe the X-ray 1. Joint space narrowing

findings of an arthritic 2. Osteophytes
knee 3. Subchondral sclerosis
4. Subchondral cyst
What is the difference The anatomic axis runs from the top of
between the anatomic the greater trochanter straight through
and mechanical axis of the center of the femur and down to the
the femur? middle of the ankle. The mechanical axis
extends from the center of the femoral
head through the medial tibial spine and
down to the center of the ankle joint
(continued)
A. Boulos, MD (*) · N. Lemme, MD

Department of Orthopedics, Brown University,
Providence, RI, USA
e-mail: nicholas_lemme@brown.edu;
alexandre_boulos@brown.edu

https://doi.org/10.1007/978-3-319-78387-1_74
166 A. Boulos and N. Lemme
(continued)
What is the normal The anatomic axis is normally 6° of
position of the valgus from the mechanical axis. In most
anatomic axis relative people with OA, this angle will be in
to the mechanical relative varus
axis? How do
those change in
osteoarthritis?
What are the most 1. Medial parapatellar approach
common approaches 2. Midvastus
for simple primary 3.Subvastus
TKA? 4. Minimally invasive
What is the interval The interval lies between the rectus
for the medial femoris muscle and the vastus medialis
parapatellar approach
to the knee?
What structure can The popliteus muscle
be identified in the
posterior aspect of the
lateral compartment of
the knee?
Which structure is Superior lateral genicular artery
responsible for blood
supply to the patella
after TKA with a
medial approach?
What are the two 1. Measured resection
most commonly 2. Gap balancing (soft-tissue tension
used techniques for balancing)
balancing the flexion
and extension gaps
during TKA?
What is the preferred External rotation of the femoral and
rotation of the femoral tibial components decreases the Q angle
and tibial components and the strain on the lateral retinaculum.
and why? This helps to prevent patella maltracking
and dislocation postoperatively
74 Total Knee Arthroplasty 167
What are the five most 1. Aseptic loosening—MCC after 2 years

common causes of 2. Septic failure—MCC within 2 years
failure in TKA? 3. Ligamentous instability/flexor
mechanism disruption
4. Periprosthetic fracture
5. Arthrofibrosis
How do the following 1. Changing the distal femur will only
affect the flexion/ change the extension gap
extension gaps, 2. Changing the femoral component size
respectively: will only change the flexion gap
1. Changing the 3. Any chance to the proximal tibia
distal femur? or the insert will change both the
2. Changing the extension and flexion gaps
femoral component
size?
3. Changing
the proximal tibia
or changing the
polyethylene insert?
What neurovascular 1. Check DP and PT pulse
structures should be 2. Check function of deep and superficial
assessed after TKA? peroneal nerves
What are risk factors 1. Poor bone quality
for periprosthetic 2. Mechanical stress-risers
fractures after TKA? 3. Neurological disorders
What classification Lewis and Rorabeck for distal femur
system is used for fractures
periprosthetic fractures Felix for tibial fractures
of the knee?
A patient with history 1. CBC, ESR, CRP, knee aspiration with
of TKA presents cell count and culture
with knee pain and 2. X-rays of the joint
instability. What
studies should you
order?
(continued)
168 A. Boulos and N. Lemme
(continued)
What is the difference Prosthetics used in TKA can be
between a constrained broadly classified as constrained or
and unconstrained unconstrained
implant? Constraint refers the valgus and varus
stability provided by the implant. An
unconstrained implant does not offer
this stability and instead relies on the
native MCL and LCL for this function
What are the two Constrained implants can either be
types of constrained hinged or unhinged. The hinge refers
implants and what are to an axle connecting the tibial and
the differences? femoral components. A nonhinged
design may be used for isolated LCL or
MCL instability while a hinged design
is preferred for global ligamentous
instability or hyperextension instability
What are the two Cruciate retaining and posterior
types of unconstrained stabilizing
implants?
What is a cruciate Cruciate retaining implants rely on an
retaining implant intact PCL for posterior stabilization.
and what are the They are usually used for patients with
indications for its use? stable knees and no significant valgus
What are pros and or varus deformities. Patients have
cons? improved proprioception and do not
experience impingement. However, a
rupture PCL may lead to instability and
a need for revision
What is a posterior Posterior stabilizing implants have a
stabilizing implant constraint that provides the stability
and what are the of the PCL, which is removed during
indications for its use? surgery. It is preferred some patients
What are pros and with inflammatory arthritis. Patients
cons? have better ROM and no risk of PCL
rupture. Disadvantages include the
possibility of impingement, dislocation,
and patellar clunk syndrome
Chapter 75
Patellofemoral Pain Syndrome
Steven F. DeFroda
What is the purpose of the Acts as a fulcrum to transmit forces

patella? across the knee
How much force does Approximately 5–10 times body
the patellofemoral joint weight
experience?
What is the first- Symptomatic management with
line management of NSAIDs, muscle strengthening
patellofemoral syndrome? around the knee, and weight loss
What is the typical Chondromalacia of the
pathology involved? patellofemoral joint
What is the outerbridge Type 1: softening
classification of Type 2: fissuring
chondromalacia? Type 3: crabmeat changes with no
subchondral bone exposed
Type 4: subchondral bone
exposed

https://doi.org/10.1007/978-3-319-78387-1_75
170 S. F. DeFroda
Reference
1. Crossley KM, Callaghan MJ, van Linschoten R. Patellofemoral
pain. BMJ. 2015;351:h3939. http://www.ncbi.nlm.nih.gov/
pubmed/26537829. Accessed 9 May 2017.
Chapter 76
IT Band Syndrome
John R. Tuttle
What anatomic structures are IT band rubbing over lateral

involved in IT band syndrome femoral condyle, pain is over
and where does it hurt? lateral femoral condyle
What limb alignment issue Genu varum or recurvatum
is associated with IT band
syndrome?
What is the origin, insertion, Continuation of tensor fascia
and innervation of the IT lata, Gerdy’s tubercle, superior
band? gluteal nerve (L1–3)
What is the main treatment IT band stretching
method?
Do the majority of patients Yes
improve without surgery?
What surgical intervention is IT band windowing over lateral
appropriate if nonoperative femoral epicondyle, IT band
treatment fails? lengthening in refractory cases

https://doi.org/10.1007/978-3-319-78387-1_76
172 J. R. Tuttle
Bibliography
1. Beals C, Flanigan D. A review of treatments for iliotibial band syn-
drome in the athletic population. J Sports Med. 2013;2013:367169.
https://doi.org/10.1155/2013/367169.
Chapter 77
Lower Extremity Tibial
Plateau Fractures
Tyler S. Pidgeon
Recite the Schatzker Type I: Lateral Split; Type II:

classification for tibial plateau Lateral Split/Depressed; Type
fractures III: Lateral Depressed; Type
IV: Medial; Type V: Bicondylar;
Type VI: Metaphysis/Diaphysis
Dissociation
What severe knee injury is a Knee dislocation
medial tibial plateau fracture
said to be equivalent to?
What test helps to rule out Ankle-Brachial Index (ABI).
a vascular injury in a patient ABI of <0.9 has high sensitivity
with a tibial plateau fracture? and specificity for diagnosis of
a vascular injury and warrants
further workup
(continued)
T. S. Pidgeon, MD

https://doi.org/10.1007/978-3-319-78387-1_77
174 T. S. Pidgeon
(continued)
After ORIF of tibial plateau Joint alignment and stability
fractures what is the best
indicator of long-term
outcomes?
What temporizing measure Knee-spanning external fixation
is indicated in a patient
with a severely displaced
tibial plateau fracture with
substantial shortening,
angulation, and/or impaction?
Patients with tibial plateau Compartment syndrome
fractures are at risk for
development of what condition
considered to be an orthopedic
emergency?
What imaging modality is most CT scan
useful in preoperative planning
for tibial plateau fractures?
Which meniscus is most Lateral meniscus
commonly torn in patients
with tibial plateau fractures?
Bicondylar tibial plateau Lateral and medial plating
fractures undergoing ORIF
should be considered for what
type of fixation?
Describe the shape and Lateral: Convex and proximal;
position of the lateral and Medial: Concave and distal
medial tibial plateau
Chapter 78
Stress Fracture
John R. Tuttle
When overuse results in Fatigue fracture (a subtype of

trabecular microfractures from stress fracture)
repetitive pressure applied to a
normal bone, it is called what?
When overuse results in Insufficiency fracture (a
trabecular microfractures from subtype of stress fracture)
repetitive pressure applied to an
abnormal bone, it is called what?
Stress fracture pain increases Activity, rest
with ____ and improves with
____
What is the most sensitive and MRI
specific diagnostic test for stress
fractures?
(continued)

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176 J. R. Tuttle
(continued)
Should all stress fractures be No (e.g., tension-sided femoral
treated without surgery, at least neck)
at first?
What athlete is at higher risk for Rowers
stress fractures in ribs 4–9?
Bisphosphonate medication has Subtrochanteric femur
been linked to what anatomic fracture
site of stress fracture?
What three conditions must you Amenorrhea, eating disorder,
address in a female athlete with a osteoporosis (female triad)
stress fracture?
What is the most common lower Tibia, accounts for half of all
extremity stress fracture site and stress fractures
how common is it among all
stress fractures?
What is the second most Metatarsals (most common:
common site for stress fractures second and third), military
and which populations tend to be recruits (marching), and ballet
affected by them? dancers (en pointe)
Bibliography
1. Astur DC, Zanatta F, Arliani GG, Moraes ER, Pochini A de
C, Ejnisman B. Stress fractures: definition, diagnosis and treat-
ment. Rev Bras Ortop. 2016;51(1):3–10. https://doi.org/10.1016/j.
rboe.2015.12.008.
Chapter 79
Metatarsalgia
Stephen Marcaccio
Define metatarsalgia. Symptom of pain experienced in

the ball of the foot
List three causes of Traumatic (MTP dislocations)
metatarsalgia. Acquired (hallux valgus)
Infectious (synovitis/
osteomyelitis)
Define Morton’s neuroma. Compressive neuropathy of the
interdigital nerve
Where is Morton’s neuroma Commonly involves the second/
most commonly located? third interdigital nerve between
the metatarsal heads
(continued)
S. Marcaccio, MD

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178 S. Marcaccio
(continued)
What physical exam findings Positive web space
are common with Morton’s compression test
neuroma? Mulder’s click (felt when
squeezing metatarsals
together)
What is the technique for Cut the interdigital nerve as far
operative management of proximal as possible to prevent
Morton’s neuroma? recurrence
Which metatarsal is the most The second metatarsal
common involved with stress
fractures?
What is the best radiographic Acute: MRI
method to detect? Acute Chronic: X-ray
osteomyelitis or chronic?
Chapter 80
Hallux Valgus
Hallux Valgus Questions and Answers

What is another common name Bunion deformity
for hallux valgus?
What two types of hallux valgus Adult and juvenile
exist?
How do you describe the great Hallux is in valgus and
toe in hallux valgus? pronated
What symptoms are common Pain over medial prominence
with hallux valgus with shoe wear, pain with
range of motion of first toe
What is the first-line treatment Shoe modification (wide toe
for hallux valgus? box shoe), toe spacers, and
orthotics
(continued)
R. J. Kadakia, MD (*) · J. T. Bariteau, MD

Department of Orthopaedic Surgery, Emory University School of
Medicine, Atlanta, GA, USA
e-mail: rishin.j.kadakia@emory.edu

https://doi.org/10.1007/978-3-319-78387-1_80
180 R. J. Kadakia and J. T. Bariteau
(continued)
Hallux Valgus Questions and Answers
What are some differences Juvenile hallux valgus is often
between adult hallux valgus and bilateral, familial, usually
juvenile hallux valgus? not painful (more cosmetic
concerns)
The sesamoids are found within Flexor hallucis brevis
which muscle’s tendons?
What is the hallux valgus angle Angle between a line through
(HVA)? the long axis of the first
metatarsal and a ling through
the long axis of the proximal
phalanx
What is the intermetatarsal angle Angle between the long axis
(IMA)? of the first metatarsal and the
second metatarsal
What is considered normal for Less than or equal to 15°
the HVA?
What is considered normal for Less than or equal to 9°
the IMA?
What are the names of some of Chevron, Mitchell
the distally based osteotomies
of the first metatarsal commonly
used in correction of hallux
valgus?
What are the names of the Scarf, Ludloff
proximally based osteotomies of
the first metatarsal commonly
used in correction of hallux
valgus?
What is the indication for a First TMTJ instability, Lapidis
Lapidus procedure? is a fusion of the first TMTJ
Chapter 81
Heel Pain
Stephen Marcaccio
What significant anatomical Achilles tendon, foot/toe flexor

tendons/nerves are located bundle, tibial neurovascular
around the heel? bundle, plantar fascia
From a lateral view, what is Anterior to posterior: tibialis
the anatomic relationship of posterior, FDL, nerve, then
the tibialis posterior, FDL, and HFL (“Tom, Dick, and
FHL? Nervous Harry”)
What are the differences in Studies have shown that
outcomes between operative there are minimal long-term
and nonoperative management differences between the two
of Achilles tendon ruptures? methods of management
What is the name of the stitch The Krackow stitch
used for Achilles tendon repair?
What is the most common type Calcaneus fracture
of tarsal fracture?
(continued)
S. Marcaccio, MD

https://doi.org/10.1007/978-3-319-78387-1_81
182 S. Marcaccio
(continued)
What are the names of the two The Essex-Lopresti and
classification systems for intra- sanders classification systems
articular calcaneus fractures?
What is a normal Bohler angle 40°
measurement?
What is a normal angle of 130–145°
Gissane?
What is the value of MRI in the Can be used to diagnose
diagnosis of calcaneus fractures? calcaneal stress fractures
in the presence of normal
radiographs or uncertain
diagnosis
Chapter 82
Ankle Sprain/Fracture
What defines a high ankle Syndesmotic injury

sprain?
What ligament is most Anterior talofibular ligament
commonly damaged in ankle (ATFL)
sprains
What are the three lateral Anterior talofibular ligament
ligaments of the ankle joint? (ATFL), calcaneofibular
ligament (CFL), posterior
talofibular ligament (PFL)
What are common associated Osteochondral fractures/defects,
injuries seen in patients with peroneal tendon pathology
ankle sprains
(continued)

Department of Orthopaedic Surgery, Emory University School
of Medicine, Atlanta, GA, USA

https://doi.org/10.1007/978-3-319-78387-1_82
(continued)
What radiograph view can be External rotation stress view
used to identify a syndesmotic
injury?
What is the normal Less than or equal to 4 mm

measurement for the medial
clear space?
What is the normal Less than or equal to 6 mm
measurement for the
tibiofibular clear space?
What imaging modality MRI
when evaluated for tendon
pathology or osteochondral
defects
What are the indications for Persistent pain and/or
surgery for ankle sprains instability after a long period of
nonoperative treatment
What is the name of the Brostrom procedure/modified
procedure involving anatomic Brostrom procedure
reconstruction of the lateral
ankle ligaments?
What is name of one Lauge-Hansen
classification system for ankle
fractures?
What is the most common Supination external rotation
type of ankle fracture based
on the Lauge-Hansen system?
Chapter 83
Talar Fracture
Gregory R. Waryasz
What is the mechanism Forced dorsiflexion with axial load

of a talar neck
fracture?
What does the lateral Posterior facet of calcaneus and lateral
process of the talus malleolus of fibula
articulate with?
What Hawkins Hawkins IV
classification has the
highest risk of AVN?
What is a Canale view? Optimal view of talar neck. Maximum
equinus, 15° pronation, and X-ray 75°
cephalad from horizontal
What should be done Clean, reduce, and ORIF
with an extruded talus?
(continued)
G. R. Waryasz, MD, CSCS

Department of Orthopaedic Surgery, Massachusetts General
Hospital, Boston, MA, USA

https://doi.org/10.1007/978-3-319-78387-1_83
186 G. R. Waryasz
(continued)
What is a Hawkins Subchondral lucency seen on mortise
sign? X-ray at 6–8 weeks representing
intact vascularity and resorption of
subchondral bone
What does a varus talar Decreased subtalar eversion and
malunion lead to? weightbearing on the lateral border of
foot
Chapter 84
Calcaneus Fracture
What is the most commonly fractured The calcaneus

bone in the foot?
What is the most common mechanism Axial loading of the
of injury that causes calcaneus foot
fractures?
The calcaneus articulates with which Talus and cuboid
other bones?
How many facets are located on Three
the superior articular surface of the
calcaneus?
The middle facet is located on the Flexor hallucis longus
sustentaculum tali of the calcaneus,
which tendon passes below this
structure?
(continued)


https://doi.org/10.1007/978-3-319-78387-1_84
(continued)
What angles obtained on a lateral Angle of Gissane and
radiograph of the calcaneus are used to Bohler’s angle
evaluate calcaneus fractures?
What other part of the body must Lumbar spine (high
be imaged in patients with calcaneus incidence of vertebral
fractures? injuries)
Which classification system for Sanders classification
calcaneus fractures requires CT scans
and examines the articular fragments
on coronal cuts?
What radiographic view is typically Harris view
obtained for calcaneus fractures
that allows for visualization of the
tuberosity and fracture alignment
(varus/valgus)?
What is the most common deformity Lateral wall blow out
seen with calcaneus fractures? with varus deformity
and shortening of the
calcaneus
Which facet of the subtalar joint is The posterior facet
most commonly fractured with intra-
articular calcaneus fractures?
Chapter 85
Lisfranc Fracture
Gregory R. Waryasz
What is the mechanism of Hyperflexion/compression/abduction

a Lisfranc fracture? moment on forefoot and transmitted
to the TMT articulation
What are the articulations Tarsometatarsal, intermetatarsal,
of the Lisfrac joint intertarsal
complex?
What the Lisfranc Medial cuneiform to base of second
ligament connect? metatarsal on plantar surface
Where is the bruising Plantar ecchymosis sign
usually present with a
Lisfranc?
What is the indication Greater than 2 mm displacement at
for ORIF with Lisfranc the Lisfranc articulation
injury?
(continued)


https://doi.org/10.1007/978-3-319-78387-1_85
190 G. R. Waryasz
(continued)
What position do you Passive abduction and pronation of
place the foot in to stress the forefoot with a fixed hindfoot
the Lisfranc Ligament?
Chapter 86
Metatarsal Fracture
Where is the most common Second MT

location of metatarsal
(MT) stress fractures?
What injury must be Lisfranc/Lisfranc equivalent injuries
looked for with multiple
proximal MT fractures?
Do MT fractures need Most heal with conservative
surgery? treatment
What medical workup Metabolic bone disease/amenorrhea
should occur in females
with MT stress fractures?
What is the primary Stiff soled shoe or CAM walker
nonoperative treatment? boot
(continued)
S. W. O’Donnell, MD (*) · B. D. Blankenhorn, MD


https://doi.org/10.1007/978-3-319-78387-1_86
192 S. W. O’Donnell and B. D. Blankenhorn
(continued)
What is a Jones fracture? Fracture of the fifth MT base in the
“watershed” region of poor bone
healing/often involving the MT—
cuboid articulation
What is a dancer’s fracture? Fracture of the fifth MT shaft
How long should patients Most MT fractures can bear
remain non-weightbearing? immediate weight as tolerated
Chapter 87
Pilon Fracture
Define a pilon fracture Fracture of tibial plafond, involves

articular surface of distal tibia,
often from a high energy axial
load
What is the chaput fragment? Fragment attached to anterior
inferior tibiofibular ligament,
anterolateral aspect of distal tibia
What initial treatment is External fixation
often used?
What advanced imaging CT scan (obtain after reduction
can be used to gather more and external fixation)
information about the
fracture?
(continued)
S. W. O’Donnell (*) · B. D. Blankenhorn, MD


https://doi.org/10.1007/978-3-319-78387-1_87
(continued)
What is a common risk factor Smoking
for wound or bone healing
issues?
What structure is the Volkmann fragment of the distal
posterior inferior tibiofibular tibia
ligament attached to?
What is the fibular Wagstaff fragment
attachment of the anterior
inferior tibiofibular ligament
called?
Chapter 88
Achilles Tendon Pathology
Gregory R. Waryasz
Where does an Achilles rupture 4–6 cm above calaneal insertion

usually occur? in the hypovascular area
What antibiotic class is Fluoroquinolones
associated with Achilles
ruptures?
What is a Thompson test? Lack of plantarflexion when
the calf is squeezed
What is the tendon can be Flexor hallucis longus
transferred in chronic Achilles
rupture cases?
What nerve is directly lateral to Sural
the Achilles tendon?
What are some risk factors to Smoking, females, steroid use,
wound healing complications open technique
following Achilles repair?
(continued)


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196 G. R. Waryasz
(continued)
What is the first line of Activity modification, shoe
treatment for insertional wear modification, physical
Achilles tendinopathy? therapy
What is the histology Disorganized collagen with
of insertional Achilles mucoid degeneration. Few
tendinopathy? inflammatory cells. Sometimes
calcium deposits
Chapter 89
Diabetic Foot
What is the most etiology of Peripheral neuropathy

diabetic foot ulcers?
What test is more sensitive Semmes-Weinstein 5.07
than light touch or two- monofilament
point discrimination
for determining loss of
protective sensation?
What are some radiographic Osteopenia, sclerosis,
findings of Charcot foot? fragmentation, joint collapse, and
destruction
What ABI is needed to 30–40 mmHg in toes and
ensure adequate vascular >70 mmHg at the ankle
health for healing?
(continued)


https://doi.org/10.1007/978-3-319-78387-1_89
(continued)
What classification system is Wagner: 0—At risk, skin intact;
used to grade ulcers? 1—Superficial; 2—Deep without
infection; 3—Deep infection; 4—
Gangrene distal to midfoot; 5—
Proximal gangrene
What are the most common Staph and strep species
infectious organisms?
Why should anaerobic 1/3 of infected diabetic feet have
antibiotic coverage be positive anaerobic cultures
considered?
What is the primary Total contact casting, frequent
treatment when no infection re-evaluation and skin checks
is present?
Chapter 90
Charcot Arthropathy
Define charcot arthropathy? Progressive disorder involving

destruction of bones and joints
due to loss of protective sensation
What is the most common Diabetes
cause of charcot arthropathy
in the foot and ankle?
What other joints are Knee, shoulder, elbow
commonly affected by charcot
arthropathy?
What are the symptoms of Swelling, warmth, erythema, not
charcot arthropathy in the always painful
foot and ankle?
(continued)


https://doi.org/10.1007/978-3-319-78387-1_90
(continued)
How can you differentiate Erythema will decrease when the
infection from charcot extremity is elevated in charcot
arthropathy in the foot and arthropathy
ankle?
What test is used commonly Semmes-Weinstein monofilament
used to diagnose diabetic testing
neuropathy in charcot?
What is the first line Total contact casting following by
treatment for charcot a CROW boot
arthropathy in the foot and
ankle?
What inflammatory markers ESR and WBC
are elevated in charcot
arthropathy?
Why is deformity correction High complication rates with
or arthrodesis not the best operative intervention
treatment strategy?
What are the temporal stages Fragmentation, coalescence,
for progression of charcot reconstruction
arthropathy?
What is the name of the Brodsky classification
anatomic classification system
for charcot arthropathy?
Chapter 91
Tarsal Tunnel Syndrome
Brian H. Cohen
What is the tarsal A fibroosseous tunnel located at the

tunnel? What are posteromedial ankle and hindfoot, the flexor
the borders of the retinaculum is roof and extends from the
tarsal tunnel? medial malleolus to the medial side of the
calcaneal tuberosity. The medial distal tibia,
talus, and calcaneus make up the floor
What is the Posterior tibial tendon, flexor digitorum
content of the longus tendon, posterior tibial artery and
tarsal tunnel in veins, tibial nerve and flexor hallucis longus
order from medial tendon, (mnemonic to help remember order:
to posterior? What Tom Dick and a Very Nervous Harry)
is a mnemonic to
remember?
(continued)
B. H. Cohen MD

https://doi.org/10.1007/978-3-319-78387-1_91
202 B. H. Cohen
(continued)
When dissecting Flexor hallucis longus
on the medial side
of ankle which
muscle has the
most distal muscle
belly?
What are the three Medial calcaneal nerve, lateral plantar
terminal branches nerve, and medial plantar nerve, within
of the tibial nerve? the tarsal tunnel just proximal and deep to
Where do they the superior edge of the abductor hallucis
branch? Which muscle, the medial calcaneal nerve branches
branches first? first
What is tarsal Tibial nerve entrapment beneath the flexor
tunnel syndrome? retinaculum or tarsal canal
What are some Bone from prior distal tibial, talar, or
causes of tarsal calcaneal fractures, tenosynovitis, ganglia/
tunnel syndrome? cysts from a tendon sheath or subtalar/
tibiotalar joints, bone and soft tissue
from rheumatoid arthritis or ankylosing
spondylitis, varicosities, neural tumor, tarsal
coalition, and fixed valgus hindfoot which
can cause a chronic traction neuropathy
What are some Dysthesias in the plantar aspect of the foot,
clinical findings toes, or medial distal calf
of tarsal tunnel
syndrome?
What are the (1) Triple compression test—ankle is plantar
two types of flexed and the foot is inverted, then digital
provocative test? compression is applied over the tibial nerve
(2) Dorsiflexion-eversion test—
maximally evert the foot and dorsiflex
the ankle passively, with all the
metatarsophalangeal joints maximally
dorsiflexed, hold position is held for
5–10 s
91 Tarsal Tunnel Syndrome 203
(continued)
What test should MRI, as most cases are caused by a space-
you order? occupying lesions
Electrodiagnostic testing can be normal
in patients with tarsal tunnel syndrome,
helps rule out systemic neuropathies, a
negative electrodiagnostic testing is not a
contraindication for surgery
What are some 6–12 weeks of ankle immobilization in a
conservative night splint, anti-inflammatory agents, and
treatment options? shoe modification or orthosis, be careful
with corticosteroid injections in this area as
concern for tendon attenuation or rupture
What are the Surgical decompression of tibial nerve.
surgical options? Patients with space-occupying lesions
Which patients do respond better to surgical decompression
better? than those with idiopathic or traumatic
causes, if no identifiable cause relief of
symptoms is not predictable
Chapter 92
Peroneal Tendon Pathology
Where do peroneal tendons Posterior lateral ankle

cause pain?
What structure is often damaged Superior peroneal
when peroneal tendons dislocate? retinaculum (SPR)
What provocative test can Pain and tenderness in
identify peroneal pathology? the posterior-lateral ankle
which increases with resisted
eversion
If symmetric weakness to Charcot-Marie-Tooth
eversion testing is present, what
additional pathology should be
considered?
What X-ray finding can suggest “Fleck sign”—an avulsion of
instability of the peroneal the distal fibular insertion of
tendons? the SPR
(continued)


https://doi.org/10.1007/978-3-319-78387-1_92
(continued)
What is the orientation of the Peroneus brevis is anterior to
tendons behind the fibula? peroneus longus
What is the common mechanism Forced inversion of a plantar
of peroneal injury? flexed foot
What imaging study can be Ultrasound
helpful for dynamic information
about the tendons?
What imaging study is the gold MRI
standard for tendon/soft tissue
pathology?
Chapter 93
Flatfoot
What musculo-tendinous structure is Posterior tibial

often found to be insufficient?
What is another term for the Spring ligament
superiomedial calcaneonavicular
ligament?
In children with recurrent ankle Tarsal coalition
sprains or rigid flatfoot, what
pathology should be evaluated?
What muscle antagonizes the Peroneus brevis
posterior tibialis?
What is the major difference between Flexible deformity (Stage
Stage II and Stage III flatfoot II) vs. Rigid deformity
deformity? (Stage III)
(continued)


https://doi.org/10.1007/978-3-319-78387-1_93
(continued)
Why can patients hurt on the outside Subfibular impingment
of their ankle in severe disease?
What is the too many toes sign? An indicator of forefoot
abduction, usually seen in
Stage IIb disease
Chapter 94
Plantar Fasciitis
Gregory R. Waryasz
What are risk factors for Obesity, decreased ankle dorsiflexion,

plantar fasciitis? weight bearing endurance activities
(dancing and running)
What are the symptoms Insidious onset of heel pain, often
of plantar fasciitis? first steps of day
Where is the patient Medial tuberosity of calcaneus/origin
usually most tender with of the plantar fascia medially
plantar fasciitis?
What is Baxter’s nerve? First branch of lateral plantar nerve
that can lead to heel pain around the
origin of the abductor hallucis
What is the first line of Pain control, splinting, stretching
treatment for plantar programs
fasciitis?
(continued)


https://doi.org/10.1007/978-3-319-78387-1_94
210 G. R. Waryasz
(continued)
How much of the plantar Medial 1/3–2/3. Do not perform a
fascia is released for complete release
chronic plantar fasciitis?
How is a plantar fascia Cast or boot immobilization
rupture treated?
Chapter 95
Morton Neuroma
Which is the most common Between the third and fourth toes
location for a Morton’s (third web space) of the foot
Neuroma?
What structure frequently Intermetatarsal ligament
causes the compression?
What structures are Interdigital branches from both
frequently compressed? medial and lateral plantar nerves
What are the disadvantages Increased wound problems, painful
to a plantar surgical scar on the weight bearing surface
approach? of the foot
What are some common Wide toe-box shoes, steroid
nonoperative therapies? injection, metatarsal pad


https://doi.org/10.1007/978-3-319-78387-1_95
Chapter 96
Arthritic Foot
What joints are fused in Subtalar, talo-navicular, calcaneo-

a triple fusion? cuboid
What is another term for Talo-calcaneal joint
the subtalar joint?
What is the difference Ankle arthrodesis involves a fusion of
between ankle the tibio-talar joint; ankle arthroplasty
arthrodesis and ankle involves replacing the tibio-talar joint
arthroplasty? with prosthetic implants
Which fractures can Calcaneal fractures
lead to increased risk of
subtalar arthritis?
What is the major risk of Abnormal loading of adjacent joints
joint fusion? with degeneration


https://doi.org/10.1007/978-3-319-78387-1_96
Chapter 97
Pelvic Ring Fractures
What X-ray view is best for evaluating Inlet view

anterior/posterior translation of the
hemipelvis, internal/external rotation
of the hemipelvis, and SI joint
widening?
What X-ray view is best for evaluating Outlet view
vertical translation of the hemipelvis
and flexion-extension of the
hemipelvis?
What is the most important Posterior sacroiliac
ligamentous structure for pelvic ligamentous complex
stability?
What are the three main injury Anterior posterior
mechanism patterns described in the compression (APC),
Young-Burgess classification? lateral compression (LC),
vertical shear (VS)
(continued)
D. B. C. Reid, MD, MPH

Department of Orthopaedics, Rhode Island Hospital, Brown

https://doi.org/10.1007/978-3-319-78387-1_97
216 D. B. C. Reid
(continued)
Injury to which structure differentiates Posterior sacroiliac
between and APC-II and APC-III ligamentous complex
injury
What is the colloquial name for and Windswept pelvis
LC-III injury? (Ipsilateral LC injury
with contralateral APC-
type injury)
In general, which pelvic injury pattern Vertical shear (VS)
is associated with the highest risk of
bleeding and hypovolemic shock?
What device can easily be applied in Pelvic binder
the emergency room to control pelvic
hemorrhage in unstable pelvic ring
injuries?
What anatomic landmark should a Greater trochanters
pelvic binder be centered over during
application?
What fluoroscopic views best define Inlet view (anterior-
the anterior-posterior and superior- posterior), outlet view,
inferior trajectories, respectively, for (superior-inferior)
iliosacral screw placement?
What nerve root is at greatest risk L5
when placing S1 iliosacral screws?
Chapter 98
Acetabular Fractures
What are the two oblique Obturator oblique: Anterior column,

pelvis (“Judet”) X-ray posterior wall. Iliac oblique: Posterior
views and what do each column, anterior wall
view best?
What are the five Posterior wall, posterior column,
“simple” types of anterior wall, anterior column,
acetabular fractures? transverse
(Letournal classification)
What are the five Posterior column/posterior
“associated” types of wall, transverse/posterior wall,
acetabular fractures? T-type, anterior column/posterior
(Letournal classification) hemitransverse, associated both
column
What feature defines an Complete dissociation between
associated both column acetabular articular surface and intact
acetabular fracture? ilium
(continued)

Department of Orthopaedics, Rhode Island Hospital,

https://doi.org/10.1007/978-3-319-78387-1_98
218 D. B. C. Reid
(continued)
Name a common Heterotopic ossification (HO).
complication after Prophylaxis can include radiation
operative fixation of therapy or indomethacin
acetabulum fractures and
how it can be prevented.
How can the lower Hip extension and knee flexion
extremity be positioned
during surgery to
minimize tension on the
sciatic nerve?
What type of injury Indicates associated both column
does the “spur sign” on acetabular fracture. Represents intact
the obturator oblique portion of iliac wing remaining in
indicate and what does anatomic position as the acetabular
this sign represent? dome and femoral head are translated
medially
Part IV
Spine
219
Chapter 99
Vertebral Disc Disease
Dominic Kleinhenz
What is the function of the Shock absorption and

intervertebral disc? mobility
What are the components of the Nucleus pulposus, anulus
intervertebral disc? fibrosus
What types of collagen make up Type II (nucleus pulposus),
those components? Type I (anulus fibrosus)
How does water content in the It decreases
disc change with aging?
How does less water affect the It becomes weaker and more
disc? stiff
(continued)
D. Kleinhenz, MD
Rhode Island Hospital Orthopaedic Surgery Residency Program,
Warren Alpert School of Medicine of Brown University,
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_99
222 D. Kleinhenz
(continued)
What is a disc protrusion? Displaced nucleus that has
not extended beyond the
anulus
What is a disc extrusion? Displaced nucleus through
the anulus
What is a disc sequestration? “Free fragment,” displaced
nucleus no longer in contact
with disc
What nerve root(s) do central Traversing (L4/5 disc
and paracentral disc herniations herniation leads to L5
effect? radiculopathy)
What nerve root (s) do foraminal Exiting (L4/5 disc herniation
and extra-foraminal disc leads to L4 radiculopathy)
herniations effect?
Chapter 100
Spondylolysis
and Spondylolisthesis
Dominic Kleinhenz
What is the pars Area between the superior and

interarticularis? inferior intraarticular processes
What is spondylolysis? A defect in the pars
interarticularis
What X-ray views look for Right and left oblique
spondylolysis?
What are X-ray findings of “Scottie dog with a collar,”
spondylolysis? lucency of the pars interarticularis
seen on oblique views of the spine
What is the common clinical A child or adolescent with back
presentation for spondylosis? pain
(continued)
D. Kleinhenz, MD
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_100
224 D. Kleinhenz
(continued)
What sport(s) have higher Gymnastics and football.
incidence of spondylosis? Sports with repetitive lumbar
hyperextension
Most common exam Hamstring tightness
finding in spondylolysis/
spondylolisthesis?
What is spondylolisthesis? Slippage of one vertebral body on
another
What are the types of Isthmic, degenerative, traumatic
spondylolisthesis?
What type of Isthmic
spondylolisthesis is caused by
the defect in the pars?
Chapter 101
Spinal Stenosis
Dominic Kleinhenz
What is spinal Narrowing of the spinal canal leading to

stenosis? pressure on the neural elements
What defines cervical Absolute cervical stenosis is defined by
stenosis? canal diameter <10 mm. Relative cervical
stenosis is defined by canal diameter
between 10 and 13 mm
What structures are Intervertebral disc, ligamentum flavum,
pathologic in lumbar facet joints
spinal stenosis?
What is neurogenic A common symptom of spinal stenosis.
claudication? Onset of bilateral buttock or leg pain
after walking a certain distance
(continued)
D. Kleinhenz, MD
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_101
226 D. Kleinhenz
(continued)
How do you Examining peripheral pulses
differentiate
neurogenic and
vascular claudication?
What is the “shopping Patients with spinal stenosis typically
cart” sign? feel better in a flexed position. Thus, they
feel better when leaning forward on the
shopping cart
Why do patients with Flexion tightens the hypertrophied
spinal stenosis feel ligamentum flavum taking some pressure
better in flexion? off the thecal sac
Which nerve root L5
is most commonly
affected in spinal
stenosis?
Where can the Centrally or in the lateral recess at
L5 nerve root be L4/5, or in the L5/S1 foramen or extra-
compressed? foraminal zone
Chapter 102
Spinal Cord Injury
Jacob Babu
What should be done Spinal precautions/stabilization, leave

on the field for a helmet in place, remove facemask
football player with
concern of cervical
spine injury?
What tract is Spinothalamic tract
responsible for
relaying pain and
temperature sensation
from the body to the
brain?
(continued)
J. Babu, MD, MHA

Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_102
228 J. Babu
(continued)
What American Spinal A: Complete injury: No preserved
Injury Association sensory or motor function, including in
(ASIA) grade is sacral segments
a SCI injury that
B: Sensory incomplete: Complete
leaves a patient with
motor deficits distal to the
no motor function,
neurological level, but some sensory
but preserved anal
is preserved. Sensation is preserved
sensation?
in the anal region and patient may
recognize light touch or pin prick in
this area
C: Motor incomplete: Motor
preservation with less than half of the
key muscles below the level of injury
having a muscle grade of 3 or above.
Voluntary anal contraction is found
on physical exam
D: Motor incomplete: Motor
preservation with half or more of the
key muscles below the level of injury
having a muscle grade of 3 or above
E: Normal sensation and motor
throughout
What level of spinal Injury to C3 or above
cord injury results in
need for mechanical
ventilation?
What physical exam Loss of the bulbocavernosus reflex
maneuver can help
identify if a patient is
in spinal shock?
Decreased blood Neurogenic shock
pressure and
decreased heart rate is
consistent with what
type of shock?
102 Spinal Cord Injury 229
What should the MAPs >85 mmHg

mean arterial pressure
(MAP) be maintained
at or above to prevent
further ischemic
damage to the spinal
cord?
What preexisting Cervical central stenosis/spondylosis
condition predisposes
a patient to central
cord syndrome?
Which spinal cord Anterior cord injury
injury pattern results
in preservation of
the dorsal columns,
with loss of motor
and sensory function
below the level of
injury?
Which incomplete Brown-Sequard syndrome
spinal cord injury
pattern is associated
with the greatest
prognosis for
functional recovery?
Chapter 103
Cervical Fracture/Dislocation
Jacob Babu
Why is spinal cord injury more The spinal canal is much

common in fracture/dislocations of larger proximally
the subaxial (C3-C7) cervical spine
than at C1/C2?
What are some radiographic The power ratio, basion-dens
parameters that help identify interval, basion-axial interval
occipitocervical dissociation?
What ligament is the key The transverse atlantal
component to maintaining stability ligament (TAL)
in C1 atlas fractures?
What type of odontoid fracture Type 2 fracture
is most likely to go on to a
nonunion?
(continued)
J. Babu, MD, MHA

Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_103
232 J. Babu
(continued)
What conditions should increase Ankylosing spondylitis,
the practitioners level of concern diffuse idiopathic skeletal
for radiographically occult or hyperostosis (DISH),
minimally displaced cervical spine ossification of the posterior
fractures? longitudinal ligament
What axial CT scan finding is Reverse hamburger sign—
suggestive of jumped cervical articular surface of facets
facets? are no longer in contact
What should be done for an Emergent closed reduction
identified cervical facet dislocation with sequential traction
and progressive neurological
worsening in the alert and
cooperative patient?
Chapter 104
Thoracolumbar Fracture
Jacob Babu
What is the normal range of thoracic 20–50°

kyphosis?
At what level does the spinal cord L1-L2
terminate and continue as the cauda
equina?
The integrity of what structure The posterior
suggests possibly maintained stability ligamentous complex
in the thoracolumbar spine despite
sustaining a burst fracture?
What other injury occurs with high Abdominal viscera
frequency concomitantly with flexion- injuries
distraction injuries or “seat belt
injuries”?
(continued)
J. Babu, MD, MHA

Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_104
234 J. Babu
(continued)
What scoring system helps guide The Thoracolumbar
practitioners on whether to manage Injury Classification and
thoracolumbar fractures operatively Severity Score (TLICS)
vs. nonoperatively?
What deformity does a practitioner Progressive kyphosis
monitor for with radiographs at follow
up when managing a patient with a
2–3 column fracture nonoperatively?
What is the potential etiology of Epidural hematoma—
progressive neurologic deficits in a especially when
spine fracture suffered by a patient anticoagulated
with ankylosis spondylitis or DISH?
What is the greatest predictor Prior vertebral
of a patient suffering a vertebral compression fractures
compression fracture in the future?
What medical management can help Bisphosphonates
prevent future vertebral compression,
fragility fractures?
Chapter 105
Lumbar Spine Conditions
Eren O. Kuris
What percentage of the 54–80%

general population will
experience low back pain
at some point in their
lifetime?
What is the most Muscle strain
common cause of low
back pain?
What percentage of low 90%
back pain resolves within
1 year?
What are risk factors for Obesity
low back pain?
(continued)
E. O. Kuris, MD

https://doi.org/10.1007/978-3-319-78387-1_105
236 E. O. Kuris
(continued)
What is the differential Muscle strain
diagnosis for low back
Disk herniation
pain?
Spinal stenosis
Lumbar radiculopathy
Abdominal aortic aneurysm
Degenerative spinal conditions
(such as spondylolisthesis)
When should you order If pain persists and does not respond
imaging for low back to conservative treatment options
pain? (such as activity modification,
NSAIDs, physical therapy)
What are some red Signs or symptoms of infection (fever,
flags that indicate that chills, etc)
imaging should be
History of cancer
obtained sooner?
Trauma
Neurologic symptoms
Symptoms concerning for cauda
equina syndrome (bowel or
bladder changes)
What are Waddell signs? A system used to evaluate a patient
for non-organic causes of back pain
– superficial and non-anatomic
tenderness
– excessive verbalization or
gesturing of pain
– nonanatomic motor or sensory
impairment
– pain with axial compression or
simulated rotation of spine
– negative straight leg raise when
patient is distracted
The presence of three or more of these findings suggests a non-organic
cause of the patient’s low back pain
105 Lumbar Spine Conditions 237
Suggested Reading
1. Biyani A, Andersson GB. Low back pain: pathophysiology
and management. J Am Acad Orthop Surg. 2004;12(2):106–15.
Review. PubMed PMID: 15089084.
2. Herkowitz HN, Garfin SR, Eismont FJ, Bel GR, Balderston RA.
Rothman-Simeone The spine. 6th ed. Philadelphia, PA: Saunders;
2011.
3. Shen FH, Samartzis D, Andersson GB. Nonsurgical management
of acute and chronic low back pain. J Am Acad Orthop Surg.
2006;14(8):477–87. Review. PubMed PMID: 16885479.
4. Waddell G, McCulloch JA, Kummel E, Venner RM. Nonorganic
physical signs in low-back pain. Spine (Phila Pa 1976).
1980;5(2):117–25. PubMed PMID:6446157.
Chapter 106
Adult Spinal Deformity
Dominic Kleinhenz
What are the normal Lumbar lordosis, thoracic kyphosis,

sagittal curves of the cervical lordosis
spine?
What is sagittal vertical Measurement of sagittal balance; plumb
axis? line from center of C7 to vertical line
from posterosuperior corner of S1
What measurement Greater than 5 cm sagittal vertical axis,
defines abnormal PT > 20°, PI-LL > 10°
positive sagittal
balance?
What is pelvic Angle formed between a line drawn
incidence? from the center of the femoral heads
and a line perpendicular to the sacral
endplate drawn from its midpoint
(continued)
D. Kleinhenz, MD
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_106
240 D. Kleinhenz
(continued)
Why is pelvic incidence It is a fixed pelvic parameter; it varies
important? from person to person, but does not
change with positioning of spine or
pelvis
How is lumbar lordosis A cobb angle is drawn from superior
measured? endplate of L1 and caudal endplate of
L5
What is the relationship Pelvic incidence should match lumbar
between pelvic lordosis within 10°
incidence and lumbar
lordosis?
How do patients Through retroversion of their pelvis
compensate for and hip and knee flexion
abnormal sagittal
balance?
Why are patients with Patients lose their ability to compensate
adult spinal deformity throughout the day
worse at end of day?
Chapter 107
Spine Tumors
Eren O. Kuris
What is the most common tumor Metastatic disease

of the spine?
What primary tumors most Breast, prostate, lung, kidney,
frequently metastasize to bone? and thyroid
What percentage of spinal column 97%
tumors are from metastatic
disease?
Where is the most common Spine, specifically, the
site of bony metastasis from a thoracic spine (second most
malignancy? common is proximal femur)
What other conditions are Multiple myeloma
associated with spine tumors?
Lymphoma
(continued)
E. O. Kuris, MD

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242 E. O. Kuris
(continued)
What scoring system can Takuhashi scoring system
determine life expectancy in a
patient with spine metastasis?
When is palliative treatment
recommended?
When the life expectancy is less
than 6 months
What are the goals of treatment Neurological decompression
for metastatic spine lesions?
Surgical stabilization
What adjuvant treatment can Radiation
be used either before or after
surgery?
If a patient has metastatic renal Preoperative embolization
cell carcinoma, what procedure to minimize bleeding
should the patient undergo before
surgical resection and stabilization
of the lesion?
Where do most malignant tumors Anteriorly (vertebral body)
occur in the spine vertebrae
Where do most benign spine Posterior elements
tumors occur?
What are some primary benign Osteoblastoma/Osteoid
spine tumors? Osteoma
Giant cell tumor
Aneurysmal bone cyst
Osteochondroma
Hemangioma
What are some primary malignant Chordoma
spine tumors?
Osteosarcoma
Ewing’s sarcoma
Chondrosarcoma
107 Spine Tumors 243
How do you distinguish Size (<2 cm in diameter is

between osteoid osteoma and osteoid osteoma; >2 cm is
osteoblastoma? osteoblastoma)
How is an osteoid osteoma/ Painful scoliosis
osteoblastoma commonly found in (nonrotational)
children?
Where do osteoid osteoma and Posterior vertebral elements
osteoblastoma usually occur in the
spine?
What is the most common primary Chordoma
malignant spine tumor in adults?
What is the most common site for Sacrum and coccyx (50% of
a chordoma? chordomas)
What are the histological features? Vacuolated physaliferous
cells with a foamy
appearance
What is the 5-year survival rate in 60%
patients with chordoma?
Suggested Reading
2011.
2. Schwab JH, Healey JH, Rose P, et al. The surgical management of
sacral chordomas. Spine. 2009;34:2700–4.
3. Tokuhashi Y, Ajiro Y, Umezawa N. Outcome of treatment for spi-
nal metastases using scoring system for preoperative evaluation
of prognosis. Spine (Phila Pa 1976). 2009;34(1):69–73. https://doi.
org/10.1097/BRS.0b013e3181913f19. PubMed PMID: 19127163.
Chapter 108
Spine Infections
Eren O. Kuris
What are the various Spinal epidural abscess

types of spine
Vertebral osteomyelitis
infections?
Discitis
Granulomatous infections (such as
spinal tuberculosis)
Postoperative wound infections
Spinal Intradural infections
(continued)
E. O. Kuris, MD

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246 E. O. Kuris
(continued)
What are risk factors History of IV drug use
for spine infections?
Immunocompromised state
Malignancy
Diabetes
Malnutrition
Recent systemic infection
History of spinal procedure
History of travel to an endemic
region
Immunosuppressive medications
What is the most Staphylococcus aureus
common pathogen?
What pathogen may be Pseudomonas aeruginosa
present in patients with
a history of IV drug
use?
What is a spinal A bacterial infection of the spine that
epidural abscess? leads to a collection of pus between the
dura and the tissue around it
How can spine Systemic symptoms (such as fevers,
infections present? chills, malaise)
Pain (can be acute or insidious
onset)
Physical examination may reveal
neurological deficits in severe cases
(such as radiculopathy, myelopathy,
or cauda equina syndrome)
108 Spine Infections 247
What labs should be – WBC count

ordered in the work-up
– ESR
of spine infections?
– CRP
– If there is concern for a systemic
infection, consider chest X-ray,
blood cultures, and a urinalysis
What imaging study MRI with gadolinium contrast
is generally the gold
standard for the
evaluation of spine
infections?
When should you begin After cultures have been obtained,
antibiotics? unless the patient is systemically ill or
has risk of neurological deterioration
What is the treatment Surgical decompression with or without
for spinal epidural stabilization
abscess?
What is the first line of Bracing with an extended course of IV
treatment for vertebral antibiotics (after a pathogen has been
osteomyelitis? identified through blood cultures or
biopsy)
How can you monitor Serial inflammatory markers, such as
the activity of spine ESR and CRP
infections?
Suggested Reading
1. Darouiche RO. Spinal epidural abscess. N Engl J Med.
2006;355(19):2012–20. Review. PubMed PMID: 17093252.
2011.
3. Tay BK, Deckey J, Hu SS. Spinal infections. J Am Acad Orthop
Surg. 2002;10(3):188–97. Review. PubMed PMID: 12041940.
Part V
Pediatric Orthopedics
Chapter 109
Angular Variations
Heather Hansen
What exam components Foot-progression angle, internal and

are including in the external rotation of the hips, thigh-foot
rotational profile? angle, and any foot deformities
What is the foot- A measurement of the degree of
progression angle? intoeing or outtoeing compared to an
imaginary straight line on the floor
What does the internal The femoral rotational variation/
and external rotation of torsion
the hip measure?
What is the thigh-foot With the child prone, the angle
angle and what does it between the axis of the thigh and the
measure? axis of the foot with the foot held in
a neutral position. It measures tibial
torsion
(continued)
H. Hansen, MD
Division of Pediatric Orthopaedic Surgery, Department of
Orthopaedics, The Warren Alpert Medical School of Brown
e-mail: hdh418@mail.usask.ca

https://doi.org/10.1007/978-3-319-78387-1_109
252 H. Hansen
(continued)
What is the typical Genu varum (bowlegged) as infant,
progression of the genu valgum (knock-kneed) from age
tibiofemoral angle in a 2 to 4
young child?
What is the average 7° of valgus
adult tibiofemoral
angle?
What are some benign Metatarsus adductus, increased or
causes of intoeing? persistent internal tibial torsion,
or increased or persistent femoral
anteversion
What are some Cerebral palsy, infantile Blount’s,
pathologic causes of metabolic bone disease, skeletal
intoeing? dysplasias
What are the main Guided growth or osteotomies
surgical strategies for
symptomatic angular
variations?
Bibliography
1. Aronsson DD, Lisle JW. The pediatric orthopaedic examination.
In: Weinstein SL, editor. Lovell and Winter’s pediatric orthopae-
dics, vol. 1. 7th ed. Philadelphia: Wolters Kluwer; 2014. p. 91–5.
Print.
2. Birch JG. The orthopaedic examination: a comprehensive over-
view. In: Herring JA, editor. Tachjian’s pediatric orthopaedics:
from the Texas Scottish Rite Hospital, vol. 1. 5th ed. Philadelphia:
Elsevier Saunders; 2014a. p. 25–6. Print.
3. Birch JG. The orthopaedic examination: clinical application. In:
Herring JA, editor. Tachjian’s pediatric orthopaedics: from the
Texas Scottish Rite Hospital, vol. 1. 5th ed. Philadelphia: Elsevier
Saunders; 2014b. p. 63–4. Print.
4. Lincoln TL, Suen PW. Common rotational variations in children.
J Am Acad Orthop Surg. 2003;11:312–20.
Chapter 110
Pediatric Fractures:
Management Principles
Aristides I. Cruz Jr
What are the minimum Two (typically AP and lateral)

number of views one
should order when
evaluating a fractured
extremity?
What is the most Distal radius
common fracture
reported in children?
Which specific types of Metaphyseal corner fractures, long
fractures are associated bone fractures in child of non-walking
with abuse/non- age, posterior rib fractures, distal
accidental trauma? humerus transphyseal fracture, multiple
fractures in various stages of healing
(continued)
A. I. Cruz Jr., MD, MBA


https://doi.org/10.1007/978-3-319-78387-1_110
254 A. I. Cruz Jr.
(continued)
Through which physeal Zone of hypertrophy
zone do Salter-Harris
I fractures typically
occur?
Which clinical finding Increasing pain medicine requirement
is most indicative of
impending compartment
syndrome in a child?
What are Harris growth These lines result from a temporary
arrest lines? slowdown of normal longitudinal
growth after injury or illness and
appear as transversely oriented,
sclerotic lines on plain X-ray and
usually duplicate the contiguous
physeal contour
Chapter 111
Radial Head Dislocation
What is a Monteggia fracture? Ulnar shaft fracture associated

with radial head dislocation
What is the Bado classification Describes Monteggia fractures
scheme? relative to direction of radial
head dislocation.
Type I: Anterior dislocation
Type II: Posterior dislocation
Type III: Lateral dislocation
Type IV: Dislocation + radius
fracture
What is the treatment for Observation
asymptomatic congenital radial
head dislocation?
(continued)


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256 A. I. Cruz Jr.
(continued)
Which direction is the Posterior
radial head most commonly
dislocated in congenital radial
head dislocation?
Which motion(s) is/are most Elbow extension/forearm
commonly lost in congenital supination
radial head dislocation?
Which radiographic line should Radiocapitellar line
be measured when evaluating
for radial head dislocation?
Chapter 112
Slipped Capital Femoral
Epiphysis
Heather Hansen
What are risk factors for Obesity, polynesian ancestry,

SCFE? endocrinopathies, radiation therapy,
renal osteodystrophy, Down syndrome
What is the more useful Stable vs. unstable, acute vs. chronic
classification of SCFE?
What defines an Inability to weight bear, even with
unstable SCFE? crutches
What is a major concern Osteonecrosis of the femoral head
with unstable SCFEs?
What are the common Hip/groin pain, limp, decreased range
findings of SCFE? of motion of the hip, and KNEE or
THIGH pain
(continued)
H. Hansen, MD
Division of Pediatric Orthopaedic Surgery, Department of
Orthopaedics, Alpert Medical School of Brown University,
Providence, RI, USA

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258 H. Hansen
(continued)
What is the obligate The hip automatically falls into
external rotation sign? external rotation with hip flexion
What radiographic view Lateral view
is most sensitive for
detecting SCFEs?
What is Klein’s line? A line drawn tangential to the
superior femoral neck on the lateral
hip radiograph
What is the presumed Development of osteoarthritis
natural history of a
severe slip?
What is the current Operative fixation
accepted treatment of
SCFEs?
Bibliography
1. Kay RM, Kim Y-J. Slipped capital femoral epiphysis. In: Weinstein
SL, editor. Lovell and Winter’s pediatric orthopaedics, vol. 2. 7th
ed. Philadelphia: Wolters Kluwer; 2014. p. 1165–221. Print.
2. Herring JA. Slipped capital femoral epiphysis. In: Herring JA,
editor. Tachjian’s pediatric orthopaedics: from the Texas Scottish
Rite Hospital, vol. 2. 5th ed. Philadelphia: Elsevier Saunders;
2014. p. 630–65. Print.
3. Thawrani DP, Feldman DS, Sala DA. Current practice in the man-
agement of slipped capital femoral epiphysis. J Pediatr Orthop.
2016;36(3):e27–37.
4. Aronsson DD, Loder RT, Breur GJ. Slipped capital femo-
ral epiphysis: current concepts. J Am Acad Orthop Surg.
2006;14(12):666–79.
Chapter 113
Congenital Hip Dislocation
Jose M. Ramirez
What are risk factors for CHD? First born, breech,

family history, female,
oligohydramnios
What is the Barlow exam Dislocation of flexed, adducted
maneuver? femur with axial load
What is the ortolani exam Reduction of dislocated hip
maneuver? with flexion, elevation, and
abduction
What is a normal alpha angle? Greater than 60°
What is the preferred treatment Pavlik harness
of a reducible hip in a patient
<6 months of age?
J. M. Ramirez, MD
Department of Orthopaedic Surgery, Alpert Medical School of

https://doi.org/10.1007/978-3-319-78387-1_113
Chapter 114
Congenital Coxa Vara
Jose M. Ramirez
What is a normal femoral neck 125–135°

shaft angle?
What is Hilgenreiner’s angle? Angle formed between
Hilgenreiner’s line and
proximal femoral physis
What surgery is typically Corrective valgus derotational
indicated for Hilgenreiner osteotomy
epiphyseal angle >60°?
J. M. Ramirez, MD
Department of Orthopaedic Surgery, Alpert Medical School

https://doi.org/10.1007/978-3-319-78387-1_114
Chapter 115
Osteochondrosis (Osgood-
Schlatter and Osteochondritis
Dissecans)
Jose M. Ramirez
What is the most common Capitellum

location for OCD in the upper
extremity of a young athlete?
What is the most common Medial femoral condyle
location for OCD of the knee?
What is Sinding-Larsen Chronic apophysitis of inferior
Johansson syndrome? pole of the patella
What can be seen on Fragmentation of the tibial
radiographs of the knee in tubercle
Osgood-Schlatter’s disease?
What is Iselin’s disease? Apophysitis of base of fifth
metatarsal
J. M. Ramirez, MD

https://doi.org/10.1007/978-3-319-78387-1_115
Chapter 116
Osteogenesis Imperfecta (OI)
Jose M. Ramirez
OI is caused by a qualitative and/or Type 1 Collagen

quantitative defect in what protein?
What medical therapy can reduce Bisphosphonate
fracture rate in OI? therapy
Signs of myelopathy on exam should Basilar invagination
raise concern for what complication
associated with OI?
What upper extremity fracture is Olecranon apophyseal
pathognomonic for OI? avulsion fracture
What lower extremity deformity Coxa Vara
associated with OI can lead to a
Trendelenburg gait?
J. M. Ramirez, MD

https://doi.org/10.1007/978-3-319-78387-1_116
Chapter 117
Child Abuse
Jose M. Ramirez
What is the chance of death 5–10%

for a child who is a victim of
unreported physical abuse?
What is the classically reported Metaphyseal corner fractures
location for concerning extremity
fractures in child abuse?
What elbow injury should raise Distal humerus physeal
concern for child abuse? separation
What is the most common Skin lesion
presenting sign in an abused
child?
True/False: Physicians are legally True
obligated to report cases of child
abuse.
J. M. Ramirez, MD

https://doi.org/10.1007/978-3-319-78387-1_117
Chapter 118
Legg-Calve-Perthes Disease
Jose M. Ramirez
What are the Waldenström Initial, fragmentation,

stages of Perthes disease? reossification, remodeling
(healing)
What is the crescent sign? Radiographically, a
subchondral fracture of
femoral head
What syndrome should be in Multiple epiphyseal dysplasia
the differential diagnosis of (MED)
a patient suspected bilateral
perthes disease?
When does fragmentation Approximately 6 months after
typically occur? the onset of symptoms
J. M. Ramirez, MD

https://doi.org/10.1007/978-3-319-78387-1_118
Chapter 119
Cerebral Palsy
Heather Hansen
What is the term used to Static encephalopathy

describe the brain lesion in
cerebral palsy?
When does the brain insult Prenatally, perinatally, or during
occur? childhood
What is the time course Progressive
of musculoskeletal
pathology?
What is the name of Gross Motor Function
the most common Classification System (GMFCS)
measurement of gross
motor function?
(continued)
H. Hansen, MD
Division of Pediatric Orthopaedic Surgery,
Department of Orthopaedics,
Alpert Medical School of Brown University,
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_119
272 H. Hansen
(continued)
What are some risk factors Low birth weight/prematurity,
for the development maternal infection, drug/
of CP? alcohol abuse, congenital brain
malformation, perinatal anoxia,
breech presentation, post-natal
infections, or head trauma
What is the main Tendon lengthening
treatment option for a
fixed musculotendinous
contracture?
What is responsible Muscle imbalance between
for hip subluxation? spasticity and contracture of
the adductors and flexors that
overpower the weaker and
noncontracted hip extensors and
abductors
What are the three surgical (1) soft tissue release for
categories of treatment subluxation or a hip at risk,
of a hip at risk of (2) reduction and reconstruction
subluxation/dislocation? of the subluxated or dislocated
hip, and (3) salvage surgery for
long-standing painful dislocations
What is the most common Scoliosis
spine problem in cerebral
palsy?
What is the typical Long, sweeping, C-shaped
appearance of a scoliosis
curve?
Bibliography
1. Kerr Graham H, Thomason P, Novacheck TF. Cerebral palsy. In:
Weinstein SL, editor. Lovell and Winter’s pediatric orthopaedics,
vol. 1. 7th ed. Philadelphia: Wolters Kluwer; 2014. p. 486–554.
Print.
119 Cerebral Palsy 273
2. Karol LA. Disorders of the brain. In: Herring JA, editor. Tachjian’s

pediatric orthopaedics: from the Texas Scottish Rite Hospital, vol.
2. 5th ed. Philadelphia: Elsevier Saunders; 2014. p. 370–85. Print.
3. Refakis CA, Baldwin KD, Speigel DA, Sankar WN. Treatment
of the dislocated hip in infants with spasticity. J Pediatr Orthop.
2016 [Epub ahead of print].
4. Aversano MW, Sheikh Taha AM, Mundluru S, Otsuka NY. What’s
new in the orthopedic treatment of cerebral palsy. J Pediatr
Orthop. 2017;31(3):210–6.
5. McCarthy JJ, D’Andrea LP, Betz RR. Scoliosis in the child with
cerebral palsy. J Am Acad Orthop Surg. 2006;14(6):367–75.
6. Karol LA. Surgical management of the lower extremity in ambu-
latory children with cerebral palsy. J Am Acad Orthop Surg.
2004;12(3):196–203.
Chapter 120
Spinal Bifida
Supplementation of what vitamin Folate

can decrease risk of spina bifida?
What lab test can be obtained in Alpha-fetoprotein (usually
the second trimester to evaluate elevated in spina bifida)
for spina bifida
What is the most common Type II Arnold-Chiari
comorbid condition with spina Malformation
bifida?
What allergy is common in Latex
patients with spina bifida?
Why is L4 considered a “key Important for quadriceps
level” for function in patients function, allows some
with spina bifida? independent community
ambulation
(continued)

Rhode Island Hospital, Brown University,
Providence, RI, USA

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276 D. B. C. Reid
(continued)
Rapid scoliosis curve progression Tethered cord and/or
in patient’s with spina bifida hydrocephalus
should raise concern for what?
What should be ordered in X-rays (pathologic fractures
patients with spina bifida common in myelodysplastic
presenting with warm, red, children, often mistaken for
swollen joints (other than infection)
infectious workup)?
Chapter 121
Charcot-Marie-Tooth Disease
Heather Hansen and Seth W. O’Donnell
What is Charcot- Hereditary motor-sensory

Marie-Tooth (CMT) neuropathy
disease?
What is the common Cavo-varus
foot deformity seen
with progressive CMT?
What muscle Weak tibialis anterior is
imbalances result from overpowered by peroneus longus;
CMT? weak peroneus brevis is overpowered
by tibialis posterior
Other than the Hip dysplasia, scoliosis, wasting
foot and ankle, of the hand intrinsic muscles
what orthopedic
manifestations of CMT
may be present?
(continued)
H. Hansen, MD (*) · S. W. O’Donnell, MD

Providence, RI, USA
https://doi.org/10.1007/978-3-319-78387-1_121
278 H. Hansen and S. W. O’Donnell
(continued)
What is often the first Plantar flexion of the first ray
foot abnormality seen
in CMT?
What test can be used Coleman block test
to assess the rigidity of
a hindfoot deformity?
What is a cavus foot? A pathologically high arch
What does “equinus” The amount of plantar flexion at the
describe? ankle; often due to a contracture of
the Achilles tendon or gastroc-soleus
complex
What are diagnostic Nerve conduction studies,
tests to perform to electromyography (EMG), and
confirm diagnosis? genetic testing. Nerve biopsy
provides definitive diagnosis
but often isn’t necessary
Bibliography
1. Thompson GH, Berenson FR. Other neuromuscular disorders.
In: Weinstein SL, editor. Lovell and Winter’s pediatric orthopae-
dics, vol. 2. 7th ed. Philadelphia: Wolters Kluwer; 2014. p. 610–5.
Print.
2. Podeszwa DA. Disorders of the peripheral nervous system. In:
Herring JA, editor. Tachjian’s pediatric orthopaedics: from the
Texas Scottish Rite Hospital, vol. 2. 5th ed. Philadelphia: Elsevier
Saunders; 2014. p. 285–97. Print.
3. Casare F, Francesco T, Matteo N, Antonio M, Carlotta C, Daniele F,
Camilla P, Sandro G. Surgical treatment of cavus foot in Charcot-
Marie-Tooth disease: a review of twenty-four cases: AAOS
exhibit selection. J Bone Joint Surg Am. 2015;97(6):e30.
121 Charcot-Marie-Tooth Disease 279
4. Schwend Richard M, Drennan JC. Cavus foot deformity in

children. J Am Acad Orthop Surg. 2003;11:201–11.
5. Nagai MK, Chan G, Guille JT, Kumar SJ, Scavina M, Mackenzie
WG. Prevalence of Charcot-Marie-Tooth disease in patients who
have bilateral cavovarus feet. J Pediatr Orthop. 2006;26(4):438–43.
6. Yagerman SE, Cross MB, Green DW, Scher DM. Pediatric ortho-
pedic conditions in Charcot-Marie-Tooth disease: a literature
review. Curr Opin Pediatr. 2012;24(1):50–60.
Chapter 122
Muscular Dystrophy
Jose M. Ramirez
What protein is defective Dystrophin

in MD?
What is the inheritance X-linked recessive
pattern of MD?
How does Becker’s MD Becker’s is related to a decrease
differ from Duchenne’s in dystrophin
MD?
What is Gower’s sign? Rising by using arms to compensate
for weakness or core muscles
What foot abnormality Equinovarus foot
is seen in MD?
J. M. Ramirez, MD

https://doi.org/10.1007/978-3-319-78387-1_122
Chapter 123
Arthrogryposis
What is the common Shoulder abdducted internally

position of the upper rotated; elbow extended; wrist
extremities? flexed with ulnar deviation
What is the common Hips flexed abducted and
position of the lower externally rotated; knees
extremities? typically extended; clubfeet
What type of clubfoot Rigid, requiring surgical release
deformity is present in
arthrogryposis?
(continued)
J. R. Schiller, MD
Adolescent and Young Adult Hip Program, Orthopaedic Surgery,
Providence, RI, USA
Division of Pediatric Orthopaedics and Scoliosis,
Hasbro Children’s Hospital, Rhode Island Hospital,
Providence, RI, USA
Division of Sports Medicine,
Providence, RI, USA
e-mail: jonathan_schiller@brown.edu

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284 J. R. Schiller
(continued)
What is the most C-shaped neuromuscular pattern
common type of spine
deformity?
What is the inheritance Autosomal recessive
pattern of arthrogryposis
multiplex congenita?
Chapter 124
Achondroplasia
Heather Hansen
What is the most Achondroplasia

common form of
dwarfism?
What zone of the growth Provisional calcification
plate is affected?
What gene is involved? Fibroblast growth factor 3 (FGFR3)
What is the inheritance Autosomal dominant
pattern?
What appearance do Trident
achondroplastic hands
have?
What appearance do the Genu varum
knees typically have?
(continued)
H. Hansen, MD
Providence, RI, USA

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286 H. Hansen
(continued)
What is the most Kyphosis at the thoracolumbar
common spine junction
deformity?
What is the common Spinal stenosis
spine problem requiring
surgery?
What is the common Foramen magnum stenosis
skull abnormality with
serious complications?
What is the key Narrowing of the L1–L5
radiographic feature interpedicular distance
on an AP lumbar spine
radiograph?
Bibliography
1. Sponseller PD, Ain MC. The skeletal dysplasias. In: Weinstein SL,
editor. Lovell and Winter’s pediatric orthopaedics, vol. 1. 7th ed.
Philadelphia: Wolters Kluwer; 2014. p. 180–6. Print.
2. Herring JA. Skeletal dysplasias. In: Herring JA, editor. Tachjian’s
pediatric orthopaedics: from the Texas Scottish Rite Hospital, vol.
2. 5th ed. Philadelphia: Elsevier Saunders; 2014. p. 370–85. Print.
3. Shirley ED, Ain MC. Achondroplasia: manifestations and treat-
ment. J Am Acad Orthop Surg. 2009;17:231–41.
Chapter 125
Other Skeletal Dysplasia
What is the inheritance pattern Autosomal recessive

of diastrophic dysplasia?
Diastrophic dysplasia is a result Sulfate transport protein

of what defect?
What are the classic findings for Hitchhiker thumb and
diastrophic dysplasia? cauliflower ears
(continued)
J. R. Schiller, MD
Adolescent and Young Adult Hip Program, Orthopaedic Surgery,
Providence, RI, USA
Division of Pediatric Orthopaedics and Scoliosis,
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_125
288 J. R. Schiller
(continued)
What gene defect is responsible RUNX 2

for cleidocranial dysplasia?
What bone is classically involved Clavicle

in cleidocranial dysplasia?
What is the genetic defect in Sox 9

campomelic dysplasia?
What is the inheritance pattern Autosomal dominant
of campomelic dysplasia?
Chapter 126
Chromosomal and
Inherited Syndromes
Jose M. Ramirez
What is trisomy 21? Down syndrome

What disease is associated Gaucher’s disease
with a deficiency in
B-glucocerebrosidase?
What is the defective protein FGR3 receptor
that leads to achondroplasia?
What is VATER? Syndromic disorders associated
with vertebral anomalies, anal
atresia, tracheoesophageal fistula,
esophageal atresia, and renal
agenesis
What is inheritance pattern Autosomal dominant
of early onset Charcot-
Marie-Tooth disease?
J. M. Ramirez, MD
Department of Orthopaedic Surgery,
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_126
Chapter 127
Arthritis
Jose M. Ramirez
What are the radiographic Joint space narrowing, marginal

signs of arthritis? osteophytes, subchondral sclerosis,
periarticular cyst formation
True or False: Water True
content in collagen
increases in osteoarthritis.
What collagen type is Type II (2)
most commonly found in
articular cartilage?
What are the layers of Superficial, intermediate, deep,
articular cartilage? tidemark
What kind of cartilage Fibrocartilage
is formed as a result of
an injury through the
tidemark?
J. M. Ramirez, MD
Department of Orthopaedic Surgery,
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_127
Chapter 128
Shoulder and Elbow
Deformities
What percentage of the 80%

humerus’ longitudinal growth
comes from the proximal
physis?
What is the gene abnormality RUNX2/CBFA1
associated with cleidocranial
dysplasia?
What form of ossification Intramembranous ossification
accounts for ossification
of the clavicle?
At what age is brachial 5–6 months
plexus birth palsy unlikely to
spontaneously recover (i.e., if
antigravity motor function is
not displayed by age ____)?
(continued)


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294 A. I. Cruz Jr.
(continued)
What trunk/nerve roots are Upper trunk/C5-C6
most commonly involved in
brachial plexus birth palsy?
What clinical manifestations Shoulder abduction/external

occur with chronic, upper rotation weakness, internal
trunk, brachial plexus birth rotation contracture, posterior
palsy? glenoid deficiency/dysplasia
What is Sprengel’s deformity? It is a congenital condition of
the shoulder that results in an
undescended scapula which
can result in abnormal motion
of the shoulder
What is the most common Cubitus varus
coronal plane deformity after
a supracondylar humerus
fracture malunion?
What is the name of the Fishtail deformity
deformity that can occur
after a distal humerus lateral
condyle non-union?
What is Panner’s disease? Osteochondrosis of the
capitellum
What is “Little Leaguer’s Proximal humeral physiolysis
Shoulder”? resulting from overuse in an
overhead throwing athlete
Avulsion fracture of the Osteogenesis imperfecta
olecranon apophysis is
associated with what
condition?
Chapter 129
Hand and Wrist Deformities
What is Madelung’s Distal radius congenital physeal

deformity? abnormality that results in distal
radial growth disturbance and
resultant increased distal radial
inclination and volar tilt
What is “gymnast’s wrist”? Distal radial physeal repetitive
stress syndrome
What is the anatomic Post-axial = ulnar sided
difference between post-axial duplication
and pre-axial polydactyly? Pre-axial = radial sided
duplication
What is the primary goal To provide a functional and stable
when surgically treating pre- thumb
axial polydactyly?
(continued)


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296 A. I. Cruz Jr.
(continued)
At what age is pediatric Two years old
trigger thumb unlikely to
spontaneously resolve?
What is the treatment for A1 pulley release

pediatric trigger thumb
that has failed to resolve
spontaneously and has failed
to respond to nonoperative
treatment?
What conditions are Thrombocytopenia absent radius
associated with radial club (TAR) syndrome
hand? Fanconi’s anemia
Holt-Oram syndrome
VACTERL syndrome
VATER syndrome
What is clinodactyly? Curvature of the digit in the
radial-ulnar plane
What is the inheritance Autosomal dominant
pattern in clinodactyly?
What is the hand “Rosebud hand”
abnormality associated with
Apert syndrome?
What is Streeter’s syndrome? Amniotic band (constriction
band) syndrome
What is the difference Simple = soft tissue involvement
between complex and simple only
syndactyly? Complex = bony synostosis
What classification scheme is Wassel classification
commonly used to describe
thumb duplications?
Chapter 130
Genu Varum
What is the name of the Blount’s disease

condition describing
pathologic proximal tibia
vara?
What medical conditions Rickets, osteogenesis imperfecta,
can lead to pathologic multiple epiphyseal dysplasia (MED),
genu varum? spondyloepiphyseal dysplasia (SED),
achondroplasia, pseudoachondroplasia
What are the risk factors Early walking, obesity, African-
for pathologic tibia vara American descent
(Blount’s disease)?
(continued)


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(continued)
Which compartment Medial compartment
of the knee does the
mechanical axis pass
through in patients with
genu varum?
What is the name of Langenskiöld classification
the classification system
commonly used to
describe pathologic tibia
vara?
Chapter 131
Genu Valgum
What is the normal amount of About 5–7°

valgus (in degrees) at skeletal
maturity?
At what age is genu valgum Age 3–4 years
most pronounced?
At what age is persistent Older than 7 years
or worsening genu valgum
considered pathologic?
What is “miserable Excess femoral anteversion
malalignment”? combined with excess external
tibial torsion
(continued)


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300 A. I. Cruz Jr.
(continued)
What is Cozen’s fracture? Proximal tibial metaphyseal
fracture which is associated
with the development of late
valgus deformity which usually
resolves spontaneously
What is the treatment of choice Temporary hemi-epiphysiodesis

for pathologic genu valgum in or “guided-growth”
skeletally immature patients?
Which X-ray should be ordered Bilateral, standing AP long-leg
to diagnose and monitor genu
valgum?
What anatomic structure is at Peroneal nerve
risk if performing a proximal
tibia lateral opening wedge
osteotomy to correct excess
proximal tibia valgus?
What is the normal range for mLFDA = 87° (85–90°)
the mechanical lateral distal MPTA = 87° (85–90°)
femoral angle (mLDFA) and
medial proximal tibial angle
(MPTA)?
Which compartment of the knee Lateral compartment
does the mechanical axis pass
through in patients with genu
valgum?
Chapter 132
Axial Rotations
Jose M. Ramirez
What is the most common Internal tibial torsion

cause of intoeing in
toddlers?
How does one measure With the patient prone, angle formed
thigh foot angle? along middle of the foot and the
ipsilateral thigh
What are two additional Metatarsus adductus, femoral
causes of intoeing in anteversion
children?
J. M. Ramirez, MD

https://doi.org/10.1007/978-3-319-78387-1_132
Chapter 133
Limb Deficiency
Jose M. Ramirez
What is the expected yearly contribution 9 mm per year/6 mm

to longitudinal growth of the distal per year
femoral physis/proximal tibial physis?
What is the expected yearly contribution 6 mm per year
to longitudinal growth of the proximal
tibial physis?
What is the preferred management Observation and/or
of a patient with a 2 cm leg length shoe lift
discrepancy?
How is a 2–5 cm leg length discrepancy Epiphysiodesis of the
typically addressed surgically? longer extremity
J. M. Ramirez, MD

https://doi.org/10.1007/978-3-319-78387-1_133
Chapter 134
Limb Length Discrepancy
A limb length discrepancy Congenital (hemihypertrophy),

(LLD) can be classified into dysplastic (hemimelia), acquired
what three groups? (trauma, tumor, infection)
What is the gold standard Radiographic assessment
for accurate limb length with limb length radiograph,
measurement? scanogram, CT scanogram, EOS
imaging
What is the average yearly 9 mm, 6 mm respectively

growth of the distal femoral
physis and proximal tibia physis?
(continued)
J. R. Schiller, MD
Adolescent and Young Adult Hip Program, The Warren Alpert
School of Medicine of Brown University, Providence, RI, USA
Division of Pediatric Orthopaedics and Scoliosis, Hasbro Children’s
Hospital, Rhode Island Hospital, Providence, RI, USA

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306 J. R. Schiller
(continued)
Surgery is indicated for a Greater than 2.5 cm
discrepancy of how much?
What is the treatment for Amputation and prosthetic
discrepancies greater than fitting
20 cm?
Accurate assessment for Bone age
surgical timing requires what
radiologic image study?
Limb length discrepancies Contralateral epiphysiodesis
greater than 5 cm consists of with lengthening using external
what surgical treatment? fixator or intramedullary device
Chapter 135
Pseudarthrosis of the Tibia
What type of bowing occurs in Anterolateral

congenital pseudoarthrosis of the
tibia?
Congenital pseudarthrosis of Neurofibromatosis type 1,
the tibia is associated with what 50%
underlying pathology?
What is the goal of treatment for To prevent fracture
anterolateral bowing of the tibia?
What is the treatment for Bracing
anterolateral bowing to prevent
fracture?
(continued)
J. R. Schiller, MD

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308 J. R. Schiller
(continued)
What is the treatment for fracture Operative fixation with
of the anterolateral bowing of the Ilizarov or intramedullary
tibia? fixation
Failure to achieve union in a Below-knee amputation
pseudarthrosis of the tibia may
require what procedure?
Chapter 136
Foot and Ankle Deformities
What are the characteristics Rigid rocker bottom deformity,

of a congenital vertical talus fixed dorsal dislocation of
(CVT)? talonavicular joint
What neuromuscular disorder Myelomeningocele
is often associated with CVT?
What test is diagnostic for Forced plantar flexion on lateral
CVT? radiograph of foot
What is the most common Clubfoot
congenital foot disorder?
(continued)
J. R. Schiller, MD
Division of Sports Medicine, Hasbro Children’s Hospital, Rhode
Island Hospital, Providence, RI, USA

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310 J. R. Schiller
(continued)
What are the characteristics of Midfoot cavus, forefoot
a clubfoot? adductus, hindfoot varus, and
equinus
What is the gold standard of Ponseti casting
clubfoot treatment?
What is the order of correction CAVE; cavus, adductus, varus,
for a clubfoot using the Ponseti equinus
casting method?
What is a bean-shaped foot Metatarsus adductus
deformity otherwise known as?
What is the primary treatment Observation/stretching
of metatarsus adductus?
What is a tarsal coalition? Abnormal connection between
two bones in the midfoot or
hindfoot
What types of coalitions can Osseous, cartilaginous, or fibrous
occur?
A coalition is often present Rigid flat foot with minimal
with what type of foot? subtalar motion
What imaging study is CT scan
preferred for the diagnosis of a
tarsal coalition?
What are the two most Calcaneal navicular,
common coalitions? talocalcaneal
What characterizes a cavovarus Elevated medial arch, plantar
foot? flexion of the first ray, hindfoot
varus
This deformity is often Charcot-Marie-Tooth disease,
associated with what tethered cord
neuromuscular or spinal cord
problems?
What test is used to distinguish Coleman block test
a flexible hindfoot?
Hindfoot varus is driven by Forefoot plantar flexion of the
what deformity? first ray
Chapter 137
Idiopathic Scoliosis
Which is more Right thoracic curve

common: right or left
thoracic curve?
Define the Cobb On PA radiograph: angle of intersection
angle. between a line drawn parallel to the
superior endplate of the superior end
vertebra and a line parallel to the inferior
endplate of the inferior end vertebra of a
curve deformity
Name indications for Atypical curve pattern (e.g., left thoracic
MRI scan prior to curve), rapid curve progression, painful
operative treatment scoliosis, neurologic signs/symptoms,
of patients with asymmetric abdominal reflex, apical
scoliosis. kyphosis of the thoracic curve, juvenile-
onset scoliosis, associated syndrome, or
congenital abnormalities
(continued)


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312 D. B. C. Reid
(continued)
What are the <25°: observation, 25–45°: bracing, >45–
commonly cited Cobb 50°: operative treatment
angle cutoffs for
different idiopathic
scoliosis treatment
modalities?
What is the goal of To stop or slow curve progression
bracing?
What is the unique Crankshaft phenomenon (anterior spine
risk of posterior continues to grow after posterior fusion,
fusion alone in increasing rotation/deformity)
skeletally immature
patients?
Chapter 138
Neuromuscular Scoliosis
Name some major ways More rapidly progressive, can

in which neuromuscular progress after skeletal maturity,
scoliosis is different than associated with pelvic obliquity,
idiopathic often longer curves involving more
vertebrae, higher rate of pulmonary
complications
In general, has bracing No
generally been proven
to improve deformity
or slow progression of
disease in patients with
neuromuscular scoliosis?
(continued)


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314 D. B. C. Reid
(continued)
Name common underlying Cerebral palsy, Rett syndrome,
conditions resulting in muscular dystrophy, Friedreich’s
neuromuscular scoliosis Ataxia, spina bifida, spinal muscular
atrophy, neurofibromatosis,
arthrogryposis, polio, traumatic
paralysis
Why is nutritional status Poor nutritional status is
important to the orthopedic associated with increased overall
surgeon treating patients complications (infection, longer
with neuromuscular intubations, longer hospital stays,
scoliosis? etc.)
What nutritional markers Albumin <3.5 g/dL, WBC
have been associated <1500 Leukocytes/μL
with increased wound
complications?
Chapter 139
Congenital Spinal Anomalies
Congenital scoliosis is Fourth–sixth week of gestation

generally caused by an error
in normal fetal development
during what time period?
What is the most common Spontaneous
inheritance pattern of
congenital scoliosis?
Name some known Alcohol, valproic acid,
maternal exposures hyperthermia, diabetes
associated with congenital
scoliosis
What is VACTERL Known association between
association? vertebral anomolies, anal atresia,
cardiac anomolies, tracheo-
esophageal fistula, renal anomalies,
and limb defects
(continued)


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316 D. B. C. Reid
(continued)
Which patients with All patients, to evaluate for
congenital scoliosis require intraspinal abnormalities
MRI before surgery?
What are the three Failure of formation, failure of
basic types of defects in segmentation, mixed
congenital scoliosis?
What congenital defect Block vertebrae
confers the lowest risk of
progression of congenital
scoliosis?
What congenital defect Unilateral unsegmented bar with
confers the highest risk of contralateral hemivertebrae
progression of congenital
scoliosis?
Chapter 140
Scheuermann’s Kyphosis
What is considered normal 20–45°

range for thoracic kyphosis?
How is Scheuermann’s Rigid thoracic kyphosis >45° with
kyphosis defined? >5° anterior wedging at three
consecutive vertebrae
Does Scheurmann’s kyphosis No
correct to normal with
hyperextension?
What are other common Compensatory lumbar
radiographic findings in hyperlordosis, spondylolysis,
patients with Scheurmann’s scoliosis, disc space narrowing,
kyphosis? end plate changes, Schmorl nodes
What degree of kyphosis is >75°
often cited as an indication
for surgery?


https://doi.org/10.1007/978-3-319-78387-1_140
Chapter 141
Cervical Spine Disorders
(Pediatric)
What pediatric syndrome is Klippel-Feil syndrome

characterized by abnormalities in
multiple cervical segments caused by
failure of normal segmentation?
Why do patients with trisomy 21 often To evaluate for
get cervical spine flexion-extension atlantoaxial instability
views prior to elective surgery? prior to intubation
What study is considered the gold Dynamic CT
standard for diagnosing rotary
atlantoaxial subluxation?
What is the name of the condition in Grisel’s disease
which a patient is diagnosed with rotary
atlantoaxial subluxation after recent
retropharyngeal abscess or respiratory
infection?
(continued)


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320 D. B. C. Reid
(continued)
What structure limits anterior translation Transverse ligament
of C1 (atlas) on C2 (axis)?
What anatomic variant of C2 is often Os odontoideum
mistaken for an odontoid fracture?
What study can help differentiate Flexion-
pediatric cervical spine extension X-rays
pseudosubluxation from true injury? (pseudosubluxaton
will reduce on
extension films)
What is it called when the odontoid Basilar invagination
migrates into the foramen magnum,
potentially impinging on the brainstem?
What advanced imaging study can CT myelogram
be used to indirectly visualize neural
elements and/or spinal cord compression
in patients who cannot undergo an MRI
Chapter 142
Spondylolysis
and Spondylolisthesis
Spondylolysis refers to a defect Pars interarticularis

or fracture of which structure?
How is spondylolisthesis Anterior translation of one
defined? vertebra on the vertebra below
it (most commonly L5 on S1)
What is spondyloptosis? Greater than 100% slip of one
vertebral body on the once
below it (Meyerding Grade 5
slip)
Which X-ray views show the Oblique radiographs
“scottie dog”?
What type of spondylolisthesis is Isthmic
most common in adolescents?
(continued)


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322 D. B. C. Reid
(continued)
What nerve root is most L5
commonly affected by L5-S1
isthmic spondylolisthesis?
What is the main structure at L5 nerve root
risk with attempted reduction of
L5-S1 spondylolisthesis?
Chapter 143
Spine Injuries
What physical exam finding Return of bulbocavernosus reflex

signals the end of spinal
shock?
What vital sign is most Pulse (neurogenic shock results in
helpful in differentiation relative bradycardia in setting of
neurogenic shock from hypotension)
hypovolemic shock?
How does the American The most caudal segment of
spinal injury association spinal cord with normal sensory
(ASIA) classification define and at least 3/5 (antigravity)
the neurologic level of injury? motor function on both sides of
the body
Why are cervical spine Large head-to-body-ratio
injuries more common in
children <8 years old?
(continued)


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324 D. B. C. Reid
(continued)
What three X-ray views are Anteroposterior (AP), lateral,
most commonly used to open-mouth odontoid
evaluate the cervical spine in
pediatric patients following
trauma?
Where do odontoid fractures Through the synchondrosis
commonly occur in children? (Salter-Harris type 1 injury)
Part VI
Systemic Conditions
325
Chapter 144
Septic Arthritis
Stephen Marcaccio
Define septic A serious orthopedic condition

arthritis. characterized by infection of synovial
joints resulting in rapid destruction of
articular cartilage
What are three 1. Bacteremia
mechanisms of joint 2. Direct inoculation
infection? 3. Contiguous spread
(adjacent osteomyelitis)
What organism is the Staph aureus
most common cause
of septic arthritis?
What is the classic Young sexually active adolescents
presentation for and young adults
Neisseria septic
arthritis?
(continued)
S. Marcaccio, MD

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328 S. Marcaccio
(continued)
What types of IV drug users
patients typically
present with SC joint
infections?
How do patients Pain in joint area, fevers (60% cases), joint
usually present with resting in position that allows maximum
septic arthritis? joint volume (FABER for hip). Warm
and tender to the touch, inability to bear
weight, no ROM
What is the classic ESR, CRP, WBC, aspirate the joint fluid
workup for suspected
septic arthritis?
What is the definitive This is an orthopedic emergency: IV abx,
treatment for septic operative irrigation and debridement and
arthritis? drainage of the joint is essential
Chapter 145
Osteomyelitis
Adam Driesman
What is the most common Staph aureus

organism found in
osteomyelitis of adults?
What is the most common Still Staph aureus, while Salmonella
organism found in species is pathognomonic
sickle cell patients with
osteomyelitis?
What is the most Hematogenous seeding, typically to
common transmission the metaphyseal region
of osteomyelitis in the
pediatric population?
(continued)
A. Driesman, MD
Department of Orthopaedics, NYU Hospital for Joint Diseases,
New York, NY, USA
Drs. Ramirez and Terek are at associated with Brown University,
Providence, RI, USA
e-mail: adam_driesman@brown.edu

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330 A. Driesman
(continued)
What is the name of a Cierny and Mader classification
common classification
scheme for chronic
osteomyelitis?
What are the four stages Stage 1: Medullary
of this classification Stage 2: Superficial
to describe anatomic Stage 3: Localized
location? Stage 4: Diffuse
What are the three types Type A: Normal
of this classification to Type B: Compromised
describe the patient’s Type C: Treatment is worse to
immune status? patient than infection
What is a sequestrum? Necrotic bone that can serve as
a source for infection in chronic
osteomyelitis. It is typically sclerotic
and avascular, thereby limiting
antibiotic penetration
What is the name of new Involucrum
bone formation that occurs
as a periosteal reaction to
chronic osteomyelitis?
What inflammatory ESR and CRP
markers are elevated in WBC is only elevated in 35% of
chronic osteomyelitis? cases
What is the gold standard Biopsy specimen for evaluation of
in diagnosis? histology and microbiology
Formation of what makes Biofilm
peri-implant infection
difficult to treat?
Chapter 146
Necrotizing Fasciitis
Adam Driesman
What is the predominant Non-group A streptococci

bacteria that causes
What are more common, Polymicrobial infections
monomicrobial or
polymicrobial infections?
What patient risk factors Immunosuppressed (AIDS/chemo),
predispose patients to DM, PVD, alcoholism, IV drug use
What is the typical clinical Rapid progression that requires
course of this infection? emergent treatment
(continued)
A. Driesman, MD
Department of Orthopaedics, NYU Langone Orthopedic Hospital,
New York, NY, USA
Providence, RI, USA

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332 A. Driesman
(continued)
What are some of the Skin abscess, bullae, blue
clinical physical exam discoloration, pain, swelling, non-
signs? pitting edema
In comparison, gas gangrene
typically described as pus that is
“dish-water soap” like appearance
What is the main origin of Minimal trauma or minor skin
infection? lesions
Note: can still occur in the absence
of trauma
What is the mainstay of Early surgical debridement and
treatment? wide-spectrum antibiotic therapy
What is the mortality rate Upwards of 30%
found in these patients?
Chapter 147
Osteoarthritis
Sean Esmende and Hardeep Singh
What are the primary 1. Extracellular matrix (90%

components of articular collagen and proteoglycan)
(hyaline) cartilage? 2. Chondrocytes
3. Water
How does water content differ Water decreases with normal
between normal aging and aging and decreases with
osteoarthritis? osteoarthritis
What are the zones of articular 1. Superficial zone
cartilage? 2. Intermediate zone
3. Deep (basal) later
4. Tidemark
5. Subchondral bone
(continued)
S. Esmende, MD (*)
The Bone and Joint Institute, Hartford Hospital,
Hartford, CT, USA
H. Singh, MD
Department of Orthopaedic Surgery, New England
Musculoskeletal Institute, University of Connecticut School
of Medicine, Farmington, CT, USA

https://doi.org/10.1007/978-3-319-78387-1_147
334 S. Esmende and H. Singh
(continued)
What effect does immobilization Leads to cartilage thinning and
have on cartilage? proteoglycan loss
With aging, what happens to – Increase in chondrocyte size
chondrocyte size and the ratio – Increase in keratin sulfate to
of keratin sulfate to chondroitin chondroitin sulfate
sulfate?
What effect does moderate Moderate running increases
repetitive loading have on cartilage thickness and
cartilage and proteoglycans? proteoglycan content
How is cartilage nourished? – Synovial fluid at the cartilage
surface
– Subchondral bone at the base
What are the different forms of 1. Elastohydrodynamic
lubrication? 2. Boundary (slippery surface)
3. Boosted (fluid entrapment)
4. Hydrodynamic
5. Weeping
What is the difference in – Deep laceration leads to
cartilage healing between a fibrocartilage healing
deep and superficial laceration? – Superficial laceration leads
to chondrocyte proliferation
with NO healing
Chapter 148
Rheumatoid Arthritis
Stuart T. Schwartz
What is the inflammatory erosive The pannus

synovial tissue in rheumatoid arthritis?
Name two hand deformities in Swan neck and
rheumatoid arthritis. boutonniere
deformities
Which joints in the hands are spared DIP joints
from synovitis in rheumatoid arthritis?
What condition should be excluded C1–C2 subluxation
before surgical intubation in rheumatoid
arthritis patients?
What are two diagnostic serologies Rheumatoid factor and
found in rheumatoid arthritis? anti-cyclic citrullinated
peptide antibodies
(continued)
S. T. Schwartz, MD
Alpert Medical School of Brown University, Providence, RI, USA
e-mail: sschwartz@lifespan.org

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336 S. T. Schwartz
(continued)
What is the name of the syndrome Felty’s syndrome
in patients with rheumatoid arthritis
associated with splenomegaly and
leukopenia (specifically, neutropenia)?
What is the name of subcutaneous Rheumatoid nodules
nodules found on the extensor surfaces
and hands of patients with rheumatoid
arthritis?
Chapter 149
Crystal-Induced Arthropathy
James Levins
What type of birefringence are Negative, yellow when parallel

gout crystals? to direction of polarization,
needle-shaped
What is the mainstay of medical NSAIDs or colchicine, if
treatment for an acute gout chronic kidney disease (CKD)
attack? then steroids
What surgical emergency has Septic arthritis—patients with
to be in your differential for an crystalline arthropathy are also
acute gout attack? at increased risk for developing
septic arthritis
What is the typical white blood 2000–50,000 WBC, neutrophil
cell (WBC) range in crystalline predominant
arthropathy?
(continued)
J. Levins, MD
Department of Orthopaedic Surgery, Brown University,
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_149
338 J. Levins
(continued)
In patients with calcium Chondrocalcinosis
pyrophosphate deposition (calcification of cartilage)
disease (pseudogout), what is a
common finding on radiographs
of the affected joint?
Chapter 150
Fibromyalgia
What are the Diffuse pain, fatigue, lack of refreshing

cardinal symptoms of sleep, cognitive symptoms (memory,
fibromyalgia? concentration)
Who is typically Younger (20–55 years) female
affected by
fibromyalgia?
What is the Amplified pain perception resulting from
pathophysiology of central sensitization
fibromyalgia?
(continued)
D. Dalal, MD, MPH (*)

Department of Medicine-Rheumatology, Brown University,
Providence, RI, USA
P. Malhotra, MD, MPH
Department of Medicine-Rheumatology, Roger Williams Medical
Center, Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_150
340 D. Dalal and P. Malhotra
(continued)
What are the Symptoms of irritable bowel syndrome,
commonly associated interstitial cystitis, headaches/migraines,
symptoms with premenstrual syndrome, depression/
fibromyalgia? anxiety, and host of other somatic
manifestations
What tests are Clinical diagnosis, inflammatory markers
performed for are normal, serologies (RF, ANA) are
diagnosis of often unremarkable
fibromyalgia?
In addition to the Primary sleep disorders like sleep apnea,
above, what diseases restless leg syndrome
should be ruled out?
What are the non- (1) Aerobic exercise, (2) Cognitive
pharmacologic behavioral therapy, (3) Evaluation of
interventions for and correction of sleep disorders (CPAP
fibromyalgia? machine, etc.) and (4) Complementary/
alternative medicine (yoga, Tai-chi,
acupuncture)
What are the Initial therapy with Amitriptyline (or
drugs approved even Cyclobenzaprine) followed by
for treatment of Duloxetine/Milnacipran/Gabapentin.
fibromyalgia? Other drugs to consider acetaminophen,
tramadol, and SSRIs. NSAIDs do not
work very well
Chapter 151
Seronegative
Spondyloarthropathies
Eren O. Kuris
What are seronegative Systemic rheumatologic

spondyloarthropathies? disorders of the axial skeleton
Why are they considered to be Because blood tests are
seronegative? traditionally negative for
rheumatoid factor, which is a
marker that can detect many
rheumatological conditions
What are some common Ankylosing spondylitis
examples of seronegative
Reactive arthritis
spondyloarthropathies?
Psoriatic arthritis
Juvenile idiopathic arthritis
Enteropathic arthritis
(continued)
E. O. Kuris, MD

https://doi.org/10.1007/978-3-319-78387-1_151
342 E. O. Kuris
(continued)
What genetic marker is Human Leukocyte Antigen B27
frequently associated (HLA-B27)
with seronegative
spondyloarthropathies?
What are some common Sacroiliitis
manifestations of these
Uveitis
conditions?
Inflammatory joint arthritis
Enthesitis
What radiographic spine Calcifications of the
features are associated with intervertebral discs and
ankylosing spondylitis? ligamentous complexes
(syndesmophytes)
Ankylosis of the facet joints
(“bamboo spine”)
What is the gold standard for Biologic drugs, such as disease-
treatment of these conditions? modifying antirheumatic drugs
(DMARDs)
For example, antitumor necrosis
factor-α inhibitors
Suggested Reading
2011
2. Khalessi AA, Oh BC, Wang MY. Medical management of anky-
losing spondylitis. Neurosurg Focus. 2008;24(1):E4. https://
doi.org/10.3171/FOC/2008/24/1/E4. Review. PubMed PMID:
18290742.
3. Kubiak EN, Moskovich R, Errico TJ, Di Cesare PE. Orthopaedic
management of ankylosing spondylitis. J Am Acad Orthop Surg.
2005;13(4):267–78. PubMed PMID: 16112983.
Chapter 152
Polymyalgia Rheumatica
What are the Pain and stiffness in the proximal muscles

symptoms of of the shoulders and/or pelvic girdle
polymyalgia
rheumatica (PMR)?
Which population Patients aged > 50 years, with average age
does PMR affect? of onset of about 70 years. Caucasians
are largely affected with a female
predominance
What are the usual Elevated erythrocyte sedimentation
laboratory findings? rate (ESR), often >100 mm/h is the
characteristic laboratory finding. But can
occur with normal or mildly elevated ESR
(>40 mm/h). C-reactive protein (CRP) is
also usually elevated
(continued)
T. Brar, MD (*) · J. S. Cunha, MD

Division of Rheumatology, The Warren Alpert School of Medicine
e-mail: joanne_szczygiel@brown.edu

https://doi.org/10.1007/978-3-319-78387-1_152
344 T. Brar and J. S. Cunha
(continued)
What other Giant cell arteritis (GCA). In patients with
rheumatologic PMR, giant cell arteritis may occur in 30%
disease is PMR of these patients. While in patients with
related to? GCA, polymyalgia rheumatica may occur
in 40–60% of these individuals
What are some New onset headache, jaw claudication,
symptoms of giant scalp tenderness, and visual changes (i.e.,
cell arteritis? vision loss)
What is the main Oral glucocorticoids. Prednisone is usually
treatment of PMR? given at starting doses of 10–20 mg per day.
Usually rapid improvement in patients’
symptoms is seen in 1–2 days
What is the usually Steroids are slowly tapered over months to
course of PMR? year(s) based on patient’s clinical response
What is the Higher doses of steroids should be started
treatment for immediately especially in patients with
suspected giant cell progressive symptoms or visual loss
arteritis?
Chapter 153
Osteoporosis
James Levins
What T-score is diagnostic for Less than −2.5

osteoporosis?
How do bisphosphonates Increase osteoclast apoptosis,
work? which inhibits bone resorption
Why is it recommended Increased incidence of atypical
that patients stop taking subtrochanteric fracture
bisphosphonates after
5 years?
What are the radiographic Lateral cortical thickening,
findings of an atypical medial spike, transverse fracture
bisphosphonate line
subtrochanteric fracture?
(continued)
J. Levins, MD
Department of Orthopaedic Surgery, Brown University,
Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_153
346 J. Levins
(continued)
What are the most common Vertebral compression fracture,
fragility fractures? hip fracture (intertrochanteric
or femoral neck), distal radius
fracture, proximal humerus
fracture
Are locking or nonlocking Locking plates—secondary to
plates typically used in poor cortical bone stock, locking
osteoporotic bone? plates provide a more rigid
construct to augment fixation
In the general population of Approximately 20–30%, with
those age > 60 years old, what rates up to 50% in high-risk
is the 1-year mortality after a populations [1]
low-energy hip fracture?
References
1. Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates
SL. The 1-year mortality of patients treated in a hip fracture pro-
gram for elders. Geriatr Orthop Surg Rehabil. 2010;1(1):6–14.
https://doi.org/10.1177/2151458510378105.
Chapter 154
Rickets and Osteomalacia
Review
Jeanne Delgado
Without mineralization due to Cartilage, bone

low calcium, ossification of ___
to ___ fails
At the end of long bones, these Epiphyseal growth plates
are open with rickets, but closed
in those with osteomalacia
Deficiency in any of these Calcium, vitamin D, phosphate
three can cause rickets or
osteomalacia.
Which organ converts Kidney
vitamin D into its active form
1–25(OH)2?
Vitamin D (increases/ Increases, increases
decreases) Ca2+ and (increases/
decreases) PO43−
(continued)
J. Delgado, MD
Children’s National Medical Center, Washington, DC, USA

https://doi.org/10.1007/978-3-319-78387-1_154
348 J. Delgado
(continued)
Parathyroid hormone Increases, decreases
(increases/decreases) Ca2+ and
(increases/decreases) PO43−
What are the top risk factors Breastfeeding without vitamin
for rickets? supplementation, darkly
pigmented skin, cities in
northern latitude
Characteristic of rickets, Chest X-ray
rachitic rosary is often seen on
which radiographic study?
Rickets can cause what spinal Scoliosis, kyphosis, lordosis
abnormalities?
With rickets, which portion of Metaphyses
long bone appears widened,
cupped, frayed, or even
invisible on radiograph?
What is often the first clinical Acute fracture
presentation of osteomalacia?
Name other subtle symptoms of Low back pain, bone pain,
osteomalacia. muscle pain, hypotonia
Chapter 155
Chronic Kidney Disease-
Mineral and Bone Disorder:
“Renal Osteodystrophy”
What are the three 1. Disorders of calcium,

components of CKD-MBD? phosphorous, parathyroid
hormone (PTH), fibroblast
growth factor 23 (FGF23),
and vitamin D metabolism
2. Derangements of bone
turnover, mineralization,
volume linear growth, or
strength
3. Extraskeletal calcification
(continued)
J. Patel, MD
Roger William Medical Center, Boston University,
Boston, MA, USA
L. Amorese-O’Connell, MD (*)
Providence, RI, USA
e-mail: laura.amorese-o’connell@va.gov

https://doi.org/10.1007/978-3-319-78387-1_155
350 J. Patel and L. Amorese-O’Connell
(continued)
What is “renal Term exclusive for bone
osteodystrophy”? morphology derangements
associated to chronic kidney
disease
What are the systems involved Kidney, bone, intestine, and
in the pathophysiology of vasculature
CKD-MBD?
What is the glomerular 40 mL/min or below
filtration rate (GFR) at which
most components of CKD-
MBD are already present?
What is the earliest stage of CKD stage 2 (estimated GFR
chronic kidney disease at 60–89 mL/min/1.73 m2)
which bone disease can be
observed?
What is a major feature of Secondary hyperparathyroidism
CKD-MBD?
What is secondary Persistently increased PTH
hyperparathyroidism? secondary to:
Increased phosphate and
FGF23 concentration in
serum
Decreased calcium and
vitamin D (calcitriol) level in
serum
Reduced vitamin D receptors,
calcium-sensing receptors,
fibroblast growth factor
receptors, and Klotho in
parathyroid gland cells
What is the intervention for Bone biopsy
definitive diagnosis of “renal
osteodystrophy”?
Chapter 156
Paget’s Disease of the Bone
What is the most common Asymptomatic disease with

clinical presentation of Paget’s incidental finding of elevated
disease of the bone (PDB)? serum alkaline phosphatase of
bone origin
What is the most common Bone pain
symptom of Paget’s disease?
What is the typical atraumatic Transverse or “Chalk-stick”
fracture of long bone in Paget’s (not spiral) fracture
patients?
What type of bone lesions are Osteolytic, osteoblastic, and
seen on plain radiographs? mixed lesions
(continued)
J. Patel, MD
Roger William Medical Center, Boston University,
Providence, RI, USA
L. Amorese-O’Connell, MD (*)
Providence, RI, USA
e-mail: laura.amorese-o’connell@va.gov

https://doi.org/10.1007/978-3-319-78387-1_156
352 J. Patel and L. Amorese-O’Connell
(continued)
What is the treatment of choice Bisphosphonates
for Paget’s disease of the bone?
How many weeks do you treat Minimum 6 weeks
in an individual with PDB
before scheduled orthopedic
surgery?
What is the most commonly Pelvis
involved joint in monostatic
(single site) disease?
What causes excessive bleeding Highly vascular stromal tissue
during orthopedic surgery in replacing normal bone marrow
patients with Paget’s disease of
the bone?
What other imaging modality Bone scan
besides plain films can be
utilized for the diagnoses of
Paget’s disease of the bone?
What is the most common Deafness
neurologic complication of
Paget’s?
Chapter 157
Systemic Lupus
Erythematosus
What is systemic lupus Chronic disease characterized

erythematosus (SLE)? by immune system dysfunction
leading to autoantibody
formation and immune complex
deposition causing organ injury
SLE predominantly affects Women of child-bearing age
which population? (15–45 years), more commonly
affecting non-Caucasian persons
What is the most common Anti-nuclear antigen (ANA),
antibody found in SLE? seen in >95% of SLE patients
Which antibodies are highly Anti-double-stranded DNA
specific for renal disease? antibody (anti-dsDNA) and
anti-Sm antibodies
(continued)
T. Brar, MD (*) · J. S. Cunha, MD

Division of Rheumatology, The Warren Alpert School
of Medicine of Brown University, Providence, RI, USA
e-mail: joanne_szczygiel@brown.edu

https://doi.org/10.1007/978-3-319-78387-1_157
354 T. Brar and J. S. Cunha
(continued)
In pregnant SLE patients, Anti-SSa (Rho) and anti-SSb
which maternal antibodies (La)
can help identify pregnancies
at risk for neonatal lupus
syndrome?
What is the antibody that is Anti-histone antibody
associated with drug-induced
lupus, which is reversible
on stopping the offending
medication?
What is the most characteristic Malar rash—erythematous rash
lupus rash? over the malar prominences
and nasal bridge that spares the
nasolabial folds
Which antibodies can help Antiphospholipid antibodies:
identify SLE patients at risk Lupus anticoagulant, anti-β2
for a hypercoagulable state? glycoprotein-I, and anti-
cardiolipin antibodies
SLE patients have a variable, Corticosteroids, typically oral
relapsing-remitting course; doses but higher intravenous
acute flares of the disease doses are used in severe, life-
and severe life-threatening threatening situations
complications need to be
treated with?
Which medication is the Hydroxychloroquine
cornerstone of SLE therapy,
which helps reduce flares
and prevent organ damage,
decreases thrombosis risk, and
improves survival of patients?
Chapter 158
Osteonecrosis
Which drugs are most Glucocorticoids and alcohol

commonly associated
with osteonecrosis?
Which medical Trauma, lupus, antiphospholipid
condition increases syndrome, decompression sickness,
the risk of getting sickle cell disease, Gaucher’s disease
osteonecrosis?
Which is the most Femoral head, femoral condyles, tibial
common site of plateaus, small bones of hand and foot
osteonecrosis?
(continued)
D. Dalal, MD, MPH (*)

Department of Medicine-Rheumatology, Brown University,
Providence, RI, USA
P. Malhotra, MD, MPH
Department of Medicine-Rheumatology, Roger Williams Medical
Center, Providence, RI, USA

https://doi.org/10.1007/978-3-319-78387-1_158
356 D. Dalal and P. Malhotra
(continued)
Which is the most MRI (Other tests used—Tc-99 Bone
sensitive test to scan)
diagnose symptomatic
osteonecrosis?
What is the Crescent sign
pathognomonic sign on
X-ray?
What is the differential Consider diagnosis of primary bone
diagnosis of marrow edema syndrome—also called
osteonecrosis? transient osteoporosis of hip (TOH),
spontaneous osteonecrosis of knee
(SONK), (causalgia, reflex sympathetic
dystrophy, complex regional pain
syndrome) [better evaluated with bone
scan]
Besides pain control Bisphosphonates, statins, anticoagulants,
and reduction of weight and vasodilators like iloprost
bearing, what other
drugs can be considered
for osteonecrosis?
What are the surgical Core decompression, bone graft,
treatment options? osteotomy, and joint replacement
Chapter 159
Benign Bone Tumors
Jose M. Ramirez, Adam Driesman, and Richard Terek
What population is Young males in the second or third

most likely to form decade of life?
an osteoid osteoma?
What is the typical Pain that is worse at night. Pain will
presentation of an improve with use of NSAIDs
osteoid osteoma?
(continued)
J. M. Ramirez, MD (*)
Department of Orthopaedic Surgery, Alpert Medical School,
A. Driesman, MD
New York, NY, USA
Providence, RI, USA
R. Terek, MD
Providence, RI, USA
e-mail: richard_terek@brown.edu

https://doi.org/10.1007/978-3-319-78387-1_159
358 J. M. Ramirez et al.
(continued)
Why are NSAIDs Cyclooxygenases and prostaglandin E2
effective in is elevated by this benign bone mass.
treatment? NSAIDs will reduce these levels
What are Cortical radiolucent nidus <1.5 cm
characteristic findings surrounded by reactive bone
ofradiographs?
What is needed to Plain radiographs are typically diagnostic
make diagnosis of an with biopsy rarely needed to confirm
osteoid osteoma?
What is the most Osteochondroma
common benign bone
tumor?
What disease is Multiple hereditary exostosis (MHE)
the most common
benign bone tumor
associated with?
What is the gene EXT1. Autosomal dominant with variable
of mutation and penetrance. Affect the prehypertrophic
inheritance pattern? chondrocytes of the physis
What is the treatment While surgery for resection is
for MHE? an indication if lesions are large enough
to cause symptoms, many patients can be
followed-up with observation alone. Most
patients are asymptomatic and never seek
medical attention at all
Where are giant Metaphysis of long bones in middle age
cell tumors typically (30–50) females
found?
How do they appear Eccentric lytic lesions
on radiographs?
Chapter 160
Malignant Bone Tumors
Adam Driesman, Jose M. Ramirez, and Richard Terek
What patient demographic Young adults. Mostly occur in

is most commonly affected the second decade of life during
by osteosarcoma? adolescent growth spurt
What skeletal sites Areas of rapid bone turnover. Distal
are most common for femur, proximal tibia, proximal
osteosarcoma? humerus
(continued)
A. Driesman, MD (*)
New York, NY, USA
Providence, RI, USA
J. M. Ramirez, MD
Department of Orthopaedic Surgery, Alpert Medical School of
R. Terek, MD
Providence, RI, USA
e-mail: richard_terek@brown.edu

https://doi.org/10.1007/978-3-319-78387-1_160
360 A. Driesman et al.
(continued)
How can osteosarcomas be Primary (85%) vs. secondary
subcategorized Surface subtypes: Perosteal,
periosteal, high grade surface
Intramedullary subtypes:
Conventional, telangiectatic, low-
grade, small-cell
What symptoms New-onset pain over several months,
are associated with swelling, fever. Pain may disrupt
osteosarcomas? sleep
What is the most Tumor stage
important prognostic Other poor prognostic factor in
factor at time of diagnosis? response to chemotherapy
What is typically seen Classically periosteal reaction
on imaging for an (Codman’s triangle). Lesion with ill-
osteosarcoma? defined borders, osteoblastic and/or
osteolytic features
What is the treatment for Limb salvage/wide
osteosarcoma? resection + preoperative and
postoperative multi-agent chemo
What are survival rates for Survival rates surpass 70%
osteosarcoma?
What age range are 40–60 for primary lesions
chondrosarcomas typically 25–45 for secondary: Arises from
found in? preexisting benign cartilage lesions
(i.e., multiple enchondromas and
multiple hereditary exostosis
In what locations are Pelvis, proximal femur, proximal
chondrosarcomas typically humerus
found?
What genetic translocation t(11:22). Formation of fusion protein
results in Ewing sarcoma? (EWS-FLI1)
What population is Ewing Patients younger than the age of 10
sarcoma the most common
nonhematologic primary
malignancy of bone?
Chapter 161
Myositis
Stuart T. Schwartz
What is a heliotrope rash? A lilac colored periorbital

rash seen in dermatomyositis
What are “mechanic’s hands”? Cracked and fissured skin on
the fingers of patients with
dermatomyositis
What antibodies are present in Anti-synthetase antibodies
myositis patients associated with
interstitial lung disease?
What serious underlying Underlying malignancy
condition needs to be looked
for in patients diagnosed
with polymyositis and
dermatomyositis?
(continued)
S. T. Schwartz, MD
Alpert Medical School of Brown University, Providence, RI, USA
e-mail: sschwartz@lifespan.org

https://doi.org/10.1007/978-3-319-78387-1_161
362 S. T. Schwartz
(continued)
What blood test is typically CPK
elevated in inflammatory
myopathy?
What myositis-specific antibody Anti-Mi-2
is seen with dermatomyositis skin
rash?
What are Gottron’s plaques? Erythematous to purple
lesions, present over the IP
and MCP joints in patients
with dermatomyositis
Index
A Acromioclavicular (AC) joint

Abdominal viscera injuries, 233 allograft reconstruction, 30
Acetabular fractures posterosuperior joint capsule,
complication, 218 30
hip extension and knee Rockwood classification, 29
flexion, 218 Zanca view and comparative
iliac oblique, 217 images, 29
obturator oblique, 217 Acute carpal tunnel syndrome,
spur sign, 218 66, 85, 104
types of, 217 Adhesive capsulitis
Achilles tendon repair, 181 demographic affected people,
Achilles tendon rupture, 181 21
first line of treatment, 196 endocrine disorders, 21
flexor hallucis longus, 195 joint capsule, 21
fluoroquinolones, 195 limited passive range of
histology of, 196 motion in external
risk factors, 195 rotation, 22
sural nerve, 195 pain of insidious onset, 21
Thompson test, 195 physical exam, 21
Achondroplasia treatment, 22
autosomal dominant, 285 Adult spinal deformity
FGFR3, 285 abnormal positive sagittal
FGR3 receptor, 289 balance, 239
foramen magnum stenosis, 286 abnormal sagittal balance, 240
genu varum, 285 lumbar lordosis measurement,
kyphosis, 286 240
provisional calcification, 285 pelvic incidence, 239
spinal stenosis, 286 sagittal vertical axis, 239

https://doi.org/10.1007/978-3-319-78387-1
364 Index
American Spinal Injury operative fixation, 308

Association (ASIA), 228 Antibiotic, 6, 8, 11, 154, 195, 198,
Angular variations 330, 332
foot-progression angle, 251 Anti-cyclic citrullinated peptide
guided growth/osteotomies, antibodies, 335
252 Anti-double-stranded DNA
internal and external rotation antibody (anti-
of hip measurement, dsDNA), 353
251 Anti-histone antibody, 354
intoeing, 252 Anti-Mi-2 antibody, 362
rotational profile, 251 Anti-nuclear antigen (ANA), 353
thigh-foot angle, 251 Antiphospholipid antibodies, 354
tibiofemoral angle in young Antiphospholipid syndrome, 355
child, 252 Anti-Sm antibodies, 353
tibiofemoral angle, adult, 252 Anti-SSa (Rho) antibodies, 354
Ankle arthrodesis, 213 Anti-SSb (La) antibodies, 354
Ankle arthroplasty, 213 Anti-synthetase antibodies, 361
Ankle-brachial index (ABI), 11, Apert syndrome, 296
148, 173, 197 Arcade of Frohse, 72
Ankle sprain/fracture Arthritic foot
ATFL ligament damage, 183 ankle arthrodesis vs. ankle
Brostrom procedure/modified arthroplasty, 213
Brostrom procedure, 184 calcaneal fractures, 213
indications for surgery, 184 risk of joint fusion, 213
lateral ligaments, 183 subtalar joint, 213
medial clear space Arthritis
measurement, 184 fibrocartilage, 291
MRI, 184 layers of articular cartilage,
osteochondral fractures/ 291
defects, 183 radiographic signs of, 291
peroneal tendon pathology, 183 Type II collagen, 291
syndesmotic injury, 183, 184 Arthritis mutilans, 117
tibiofibular clear space Arthrocentesis, 4
measurement, 184 Arthrodesis, 4
Ankylosing spondylitis, 341, 342 Arthrogryposis, 314
Anterior cord injury, 229 autosomal recessive, 284
Anterior cruciate ligament clubfoot deformity, 283
(ACL), 147 lower extremities, position of,
acute, 147 283
technical error, 148 spine deformity, 284
Anterior posterior compression upper extremities, position of,
(APC), 215 283
Anterior talofibular ligament Arthroplasty, 4
(ATFL), 183 Arthroscopy, 4
Anterolateral bowing Articular (hyaline) cartilage
bracing, 307 components, 333
Index 365
destruction, 12 musculocutaneous nerve, 37

zones, 333 popeye deformity, 38
Atlantoaxial instability, 319 posterior interosseous nerve
Atraumatic, multidirectional, and lateral antebrachial
bilateral, rehabilitation, cutaneous nerve, 38
and occasionally Bicondylar tibial plateau
requiring an inferior fractures, 174
capsular shift Biofilm, 330
(AMBRI), 31 Biologic drugs, 342
Atypical bisphosphonate Bipartite patella, 160
subtrochanteric Bisphosphonates, 140, 265, 345
fracture, 345 osteonecrosis, 356
Avascular necrosis (AVN), 10, 81 PDB, 352
bisphosphonates, 140 Blood products, transfusion, 13
definition, 139 Blount’s disease, 297
direct causes of, 139 Bone biopsy, 350
indirect causes of, 139 Bone heals, types of, 8
MRI, 140 Bone pain, 351
operative interventions for Bone scan, 352
management, 140 Both bone fracture, 62
Steinberg Classification, 140 Boutonniere, 118
Avulsion fracture, 294 Boutonniere deformity, 96, 109,
Axonotmesis, 111, 112 335
Boxer’s fractures
complication, 92
B fourth and fifth metacarpals,
Bado classification scheme, 63, 91
255 interossei muscles cause apex
Bag of bones technique, 46 dorsal deformity, 91
Bamboo spine, 342 operative indications, 92
Bankart lesion, 31 surgical options for fixations,
Baxter’s nerve, 209 92
Bean-shaped foot deformity, 310 true lateral radiographs, 91
Bennett fracture, 87 Brachial plexus birth palsy, 293,
B-glucocerebrosidase, 289 294
Biceps tendon rupture Brachioradialis, 64
bicipital tuberosity of the Bracing, idiopathic scoliosis, 312
radius, 37 Brodsky classification, 200
coracoid process and superior Brostrom procedure/modified
glenoid, 37 Brostrom procedure,
eccentric contraction, 38 184
Hook test, 38 Brown-Sequard syndrome, 229
imaging test, 38 Bulbocavernosus reflex, 323
lacertus fibrosus, 38 Bunion deformity, see Hallux
lacertus fibrosus originate and valgus
insert, 37 Burst fracture, 233
366 Index
C types of dissociative
Calcaneal fractures, 202, 213 instability, 103
Calcaneal navicular coalitions, X-ray findings, 103
310 Carpal tunnel syndrome
Calcaneofibular ligament (CFL), diagnostic test, 68
183 digits, 67
Calcaneus fractures, 182 lunate, 67
facets, 187 median nerve, 67
flexor hallucis longus, 187 night splints, 68
Gissane angle and Bohler’s nonsurgical treatments, 68
angle, 188 physical exam tests, 68
Harris view, 188 risk factors, 67
lateral wall blow out with symptoms, 67
varus deformity, 188 transverse carpal ligament, 68
lumbar spine, 188 Carpometacarpal (CMC) joint,
mechanism of, 187 97
posterior facet, 188 Cartilaginous coalitions, 310
Sanders classification, 188 Cauda equine syndrome, 12
shortening of the calcaneus, Cavovarus foot, 310
188 Cavo-varus foot deformity, 277
talus and cuboid bones, 187 Cavus foot, 278
Calcific tendinitis Cefazolin, 8
definition, 23 Central pain sensitization, 339
first-line treatment, 24 Central slip, 10
nonoperative management, Central slip injury, 109
24 Cerebral palsy, 314
phases, 23 brain insult, 271
risk factors, 23 GMFCS, 271
subacromial impingement hip subluxation, 272
tests, 24 scoliosis curve appearance,
supraspinatus, 23 272
treatment, 24 spine problem, 272
Calcitriol, 350 static encephalopathy, 271
Calcium, 23, 24, 196, 338, 347, 349, surgical categories, 272
350 treatment, 272
Calcium pyrophosphate Cerebral palsy (CP), risk factors,
deposition disease, 338 272
Campomelic dysplasia Cervical facet dislocation, 12
autosomal dominant, 288 Cervical spine fractures
Sox 9, 288 closed reduction with
Caput ulna, 118 sequential traction, 232
Carpal instability odontoid fracture, 231
classifications, 103 radiographic parameters, 231
perilunate injuries, reverse hamburger sign, 232
classification of, 103 spinal cord injury, 231
surgical option, 104 TAL, 231
Index 367
Cervical spine injuries, 323, 324 Chronic fatigue

Cervical stenosis, 225 syndrome, 339
Chalk-stick fracture, 351 Chronic flexor tendon injuries,
Chaput fragment, 193 107
Charcot arthropathy Chronic kidney disease-mineral
Brodsky classification, 200 and bone disorder
definition, 199 (CKD-MBD)
diabetes, 199 components, 349
erythema, 200 feature, 350
ESR and WBC, 200 pathophysiology, 350
first line treatment, 200 stages, 350
Semmes-Weinstein Chronic pain syndrome, 339
monofilament testing, Chronic plantar fasciitis, 210
200 Cierny and Mader classification,
symptoms of, 199 330
temporal stages for Clamshell bracing, 307
progression, 200 Clavicle fractures
Charcot foot, 197 anterior versus posterior
Charcot-Marie-Tooth (CMT) displacement, 27
disease, 205 hardware removal, 28
autosomal dominant, 289 intramembranous ossification,
cavo-varus foot deformity, 277 27
cavus foot, 278 lateral third clavicle fractures,
Coleman block test, 278 28
diagnostic tests, 278 ligaments attachment, 28
equinus, 278 middle third clavicle fracture,
first foot abnormality, 278 28
hereditary motor-sensory Cleidocranial dysplasia, 293
neuropathy, 277 clavicle, 288
muscle imbalances, 277 RUNX 2 gene, 288
Chevron osteotomy, 180 Clinodactyly, 296
Child abuse Closed reduction and
distal humerus physeal percutaneous pinning
separation, 267 (CRPP), 3
metaphyseal corner fractures, Clubfoot, 309, 310
267 Clubfoot deformity, 283
skin lesion, 267 Cobb angle, 311
unreported physical abuse, Cold complex regional pain
267 syndrome, 121
Chondrocalcinosis, 338 Cold ischemia, 115
Chondroitin sulfate, 334 Coleman block test, 310
Chondromalacia of Collar button abscess, 124
patellofemoral joint, Colles fracture, 65
169 Compartment syndrome, 154, 174
Chondrosarcomas, 360 diagnostic test, 12
Chordoma, 242, 243 physical exam findings, 12
368 Index
Compensatory lumbar elbow dislocation, 51

hyperlordosis, 317 intra-articular structure, 51
Complete articular bicolumn medial ulnar collateral
fractures, 45 ligament insertion, 51
Complete transverse patella Regan and Morrey
fractures, 152 classification, 51
Complex and simple syndactyly, terrible triad injury, 51
296 Corticosteroids, 354
Complex regional pain syndrome Coxa vara, 265
(CRPS), 356 Cozen’s fracture, 300
chronic form of, 121 Crankshaft phenomenon, 312
diagnosis of, 121 C-reactive protein (CRP), 343
symptoms of, 121 Crescent sign, 356
treatment options, 122 Cruciate retaining implant, 168
vitamin C, 122 Crystal-induced arthropathy
Composite graft technique, 99 gout crystals, 337
Computed tomography (CT), 6 medical treatment, 337
Congenital coxa vara pseudogout, 338
femoral neck shaft angle, 261 surgical emergency, 337
Hilgenreiner epiphyseal WBC, 337
angle, 261 Cubital tunnel syndrome
Congenital foot disorder, 309 (CuTS), 18
Congenital hip dislocation (CHD) common hand functions, 70
Barlow exam maneuver, 259 compression distal to medial
normal alpha angle, 259 epicondyle, 69
ortolani exam maneuver, 259 compression of ulnar nerve,
risk factors, 259 site of, 69
treatment of, 259 compression proximal to
Congenital pseudarthrosis of medial epicondyle, 69
tibia (CPT) diagnosis, 70
anterolateral bowing, 307, 308 Froment’s sign, 70
below-knee amputation, 308 nonoperative options, 70
neurofibromatosis type 1, 307 provocative tests, 70
Congenital scoliosis superficial nerve, 70
inheritance pattern, 315 surgical options, 70
in normal fetal development, symptoms of, 69
315 Cubitus varus deformity, 294
risk of progression, 316
types, 316
VACTERL association, 315 D
Congenital vertical talus (CVT) Damage control orthopedics, 14,
characteristics, 309 146
diagnostic test, 309 Dancer’s fracture, 192
neuromuscular disorder, 309 Dashboard injury, 134, 148
Contralateral hemivertebrae, 316 De Quervain’s tenosynovitis, 17
Coranoid fracture abductor pollicis longus, 75
anterior capsule of elbow, 51 extensor pollicis brevis, 75
Index 369
Finkelstein test, 76 DIPJs, 119

first dorsal compartment of Direct end-to-end nerve repair,
the wrist, 75 112
location of pain, 75 Disc extrusion, 222
nonoperative treatment, 76 Disc protrusion, 222
superficial branch of the Disc sequestration, 222
radial nerve, 76 Disc space narrowing, 317
surgical treatment, 76 Discitis, 245
Deafness, 352 Disease-modifying
Decompression sickness, 355 antirheumatic drugs
Degenerative arthritis of hand (DMARDs), 118, 342
and wrist Disk herniation, 236
DIPJs, 119 Dislocation reduction, 10
DRUJ, 120 Distal femoral fractures
PIPJs, 119 age distribution of, 157
SLAC wrist, 119, 120 angiography, indication for, 158
SNAC, stages of, 119 classification, 157
thumb CMC OA, 120 complications after treatment,
thumb MCP, 119 158
Degenerative joint disease of CT scan, indication for, 158
elbow definition, 157
articular cartilage, 55 imaging study, 158
articulations, 55 implants, 158
elbow arthritis, 55 mechanism of injury, 157
total elbow arthroplasty, 56 nonoperative treatment, 158
Delayed union, 8, 40 popliteal artery, 158
Dermatomyositis, 361, 362 surgery, 158
Diabetic foot treatment for, 158
ABI, 197 typical displacement of, 158
anaerobic antibiotic, 198 Distal femoral physis, , indication
Charcot foot, 197 for, 303
infectious organisms, 198 Distal humerus fractures
primary treatment, 198 bag of bones technique, 46
Semmes-Weinstein 5.07 classification, 45
monofilament, 197 complete articular bicolumn
ulcers fractures, 45
classification system, 198 complications, 46
etiology of, 197 computed tomography
Diabetics, trigger finger, 79 scanning, 45
Diastrophic dysplasia double arch sign, 46
autosomal recessive, 287 nonoperative
hitchhiker thumb and management, 46
cauliflower ears, 287 operative options, 46
sulfate transport protein, 287 partial articular single column
Diffuse idiopathic skeletal fractures, 45
hyperostosis surgical approaches to the
(DISH), 232 elbow, 46
370 Index
Distal humerus physeal ulnar nerve, 56

separation, 267 Elbow dislocations
Distal radial ulnar joint (DRUJ), complications, 54
49, 118, 120 direction of, 53
Distal radius fracture, 122, 253, 346 dynamic stabilizers, 53
acute carpal tunnel posterolateral, 53
syndrome, 66 primary static stabilizers, 53
colles fracture, 65 surgical indications, 54
Dexa scan, 65 terrible triad, 54
distal radial-ulnar joint, 65 typical position of splinting,
smiths fracture, 65 54
triangular fibrocartilage Elson’s test, 110
complex, 66 End plate changes, 317
volar tilt, 65 Enteropathic arthritis, 341
Distal segment, 4, 7, 146 Enthesitis, 342
Distal ulna fracture, 66 Epidural hematoma, 234
Dorsal dislocation, 10, 309 Epineural repair, 112
Dorsal distal interphalangeal Epiphyseal growth plates, 347
(DIP) joint Epiphysiodesis, 303, 306
dislocations, 96, 119 Equinovarus foot
Dorsiflexion-eversion test, 202 deformity, 281
Double arch sign, 46 Erythema, 200
Down syndrome, 257, 289 Erythrocyte sedimentation rate
Dupuytren’s disease (ESR), 343
collagenase enzyme, 77 Essex-Lopresti and sanders
complication, surgical classification systems,
excision, 78 182
myofibroblasts, 77 Essex-Lopresti injury, 49
palm to table test, 77 Essex-Lopresti lesion, 64
small and ring fingers, 77 Ewing sarcoma, 360
spiral cord, 78 Extensor carpi radialis brevis
surgical treatment, 78 (ECRB), 41
tissue, cause of, 77 Extensor lag, 152, 161
Durkan’s carpal compression Extensor mechanism, 159
test, 18 Extensor mechanism injuries
Dwarfism, 285 complete transverse patella
fractures, 152
components, 151
E Krackow, 152
Eccentric lytic lesions, 358 physical exam, 152
Eichhoff maneuver, 76 Extensor tendon injuries
Elbow arthritis classic nonoperative
cause of, 55 treatment, 110
indication for total elbow Elson’s test, 110
arthroplasty, 56 EPL rupture, treatment for, 110
terminal extension, 56 fight bite injury, 109
Index 371
nondisplaced distal radius symptoms, 340

fractures, 110 treatment, 340
operative options, 110 younger female, 339
zone I injury, 109 Fibrous coalitions, 310
zone III injury, 109 Fight bite injury, 109
Zone VI, 109 Finger metacarpal fractures
External fixator, 4 indications for surgical
Extensor pollicis longus (EPL) management, 97
rupture, 110 nonoperative management, 97
External snapping hip shaft angulation
anatomic structures, 127 acceptability, 97
surgical treatment for, 127 Finkelstein test, 76
trendelenburg gait, 127 First-generation cephalosporin, 8
Extracorporeal shockwave First metacarpal base fracture, 87
therapy, 24 Fishtail deformity, 294
Extraskeletal calcification, 349 Fixed musculotendinous
Extremity shortening, 10 contracture, 272
Flat foot
flexible deformity (Stage II)
F vs. rigid deformity
Fanconi’s anemia, 296 (Stage III), 207
Fasciectomy, 78 forefoot abduction, 208
Fatigue fracture, 175 peroneus brevis, 207
Felon, 123 subfibular impingment, 208
Felty’s syndrome, 336 tarsal coalition, 207
Femoral head, 10, 135, 141, 165, Fleck sign, 205
218, 239, 257, 355 Flexible hindfoot, 310
Femoral head fractures, 134, 269 Flexor digitorum profundus
Femoral neck fractures (FDP), 106
orthopedic complications, 129 Flexor digitorum superficialis
Femoral shaft fractures (FDS), 106
external fixation, 146 Flexor hallucis longus tendons,
intramedullary nailing, 146 202
operative extremity, 145 Flexor pulley system, 106
Femur fracture, blood loss, 13 Flexor tendon
Fibroblast growth factor 3 diffusion, 107
(FGFR3), 285 lacerations, 107
Fibroblast growth factor 23 zones, 105
(FGF23), 350 Flexor tenosynovitis, 124
Fibromyalgia Fluoroquinolones, 195
cardinal symptoms, 339 Foot progression angle, 301
diagnosis, 340 Foramen magnum stenosis, 286
non-pharmacologic Forefoot abduction, 208
interventions, 340 Forefoot plantar flexion, 310
pathophysiology, 339 Four-corner arthrodesis (FCA), 120
primary sleep disorders, 340 Fracture, 6, 7
372 Index
Fragility fractures, 346 shoulder internal rotators

Friedreich’s Ataxia, 314 overpower external
Froment’s sign, 70 rotators, 32
Full range of motion (FROM), 3 TUBS, 31
Glomerular filtration rate
(GFR), 350
G Golfer’s elbow
Galeazzi fracture cause of, 42
brachioradialis, 64 classic exam findings, 42
DRUJ injury, 64 effective treatment, 42
Essex-Lopresti lesion, 64 neurologic disorder, 42
pronator quadratus, 64 Gottron’s plaques, 362
treatment, 64 Gout crystals, 337
Gamekeeper’s thumb, see Skier’s Gower’s sign, 281
thumb Graded motor therapy, 122
Garrod’s pads, 78 Granulomatous infections, 245
Gas gangrene, 124, 332 Greater trochanter, 127
Gaucher’s disease, 289, 355 Grisel’s disease, 319
Genu valgum, 252 Gross Motor Function
age, 299 Classification System
Cozen’s fracture, 300 (GMFCS), 271
lateral compartment, 300 Grouped fascicular repair, 112
miserable malalignment, 299 Gustilo-Anderson classification,
normal amount, 299 11, 154
proximal tibia lateral opening Guyon’s canal
wedge osteotomy, 300 boundaries of, 72
treatment of choice, 300 ulnar nerve, 72
Genu varum, 252, 285 zones of, 72
Langenskiöld classification, Gymnast’s wrist, 295
298
medial compartment, 298
medical conditions, 297 H
risk factors, 297 Hallux valgus
Giant cell arteritis (GCA), 344 adult and juvenile, 179
symptoms, 344 Chevron osteotomy, 180
treatment, 344 first-line treatment, 179
Giant cell tumors, 358 HVA, 180
Glenohumeral arthritis, 20 IMA, 180
Glenohumeral joint Lapidus procedure,
AMBRI, 31 indications for, 180
Bankart lesion, 31 Ludloff osteotomy, 180
HAGL lesion, 32 Mitchell osteotomy, 180
Hill Sachs lesion, 31 Scarf osteotomy, 180
lightbulb sign, 32 sesamoids, 180
posterior dislocations, 32 symptoms, 179
posterior glenoid, 32 Hallux valgus angle (HVA), 180
Index 373
Hamate fractures, carpal tunnel conservative treatment for,

view, 83 137
Hand infections definition, 137
collar button abscess, 124 lateral femoral cutaneous
deep spaces of the hand, 123 nerve, 138
Eikenella corrodens (human physical exam for patient, 137
bite), 123 posterior, 138
gas gangrene, 124 radiographic findings, 137
Kanavel’s signs, 124 Southern/Moore, 138
necrotizing fasciitis, 124 Hip osteonecrosis, see Avascular
Parona’s space, 123 necrosis
Pasteurella multocida (cat Hoffa fracture, 158
bite), 123 Holt-Oram syndrome, 296
Hawkins classification, 185 Hook test, 38
Hawkins sign, 186 Hornblower’s sign, 20
Heel Human leukocyte antigen B27
anatomical tendons/nerves, (HLA-B27), 342
181 Humeral avulsion of the inferior
anterior to posterior, 181 glenohumeral ligament
Heel pain (HAGL), 32
Achilles tendon ruptures, 181 Humeral shaft fractures, 14
intra-articular calcaneus complications, 40
fractures, 182 indications for operative
MRI, 182 management, 40
normal angle of Gissane, 182 mechanism of, 40
normal Bohler angle neurovascular injuries, 40
measurement, 182 nonoperative treatment, 40
tarsal fracture, 181 operative treatments, 40
Heliotrope rash, 361 primary deforming forces, 39
Heterotopic ossification (HO), reduction criteria for
218 nonoperative
Hill Sachs lesion, 31 management, 39
Hindfoot varus, 310 Hydroxychloroquine, 118, 354
Hip dislocations Hypothenar tenderness, 84
anterior, 134
characteristics, 133
classification, 133 I
complications, 135 Idiopathic scoliosis
CT scan, 134 bracing, 312
incidence of, 133 indications, 311
physical exam findings, 10 posterior fusion, 312
posterior, 133, 134 right thoracic curve, 311
treatment, 134 treatment modalities, 312
Hip fracture, 346 Iliotibial (IT) band syndrome
Hip osteoarthritis anatomic structures, 171
anterior, 138 limb alignment issue, 171
374 Index
surgical intervention, 171 K

treatment method, 171 Kanavel’s signs, 124
Iliotibial band snapping, 127 Kienbock’s disease
Inflammatory erosive synovial classic radiographic risk
tissue, 335 factor, 74
Inflammatory joint arthritis, 342 natural history of, 74
Injury Severity Score (ISS), 14 pathophysiology, 73
Insufficiency fracture, 175 stages of, 73
Intermetatarsal angle (IMA), 180 surgical options, 74
Intermetatarsal ligament, 211 typical history of a patient, 74
Internal tibial torsion, 301 Klein’s line, 258
Intervertebral disc Klippel-Feil syndrome, 319
central and paracentral disc Klotho, 350
herniations effect, 222 Knee dislocation, 10
collagen, 221 Knee injury
components of, 221 ACL
disc extrusion, 222 anterior tibial translation,
disc protrusion, 222 147
disc sequestration, 222 technical error, 148
foraminal and extra-foraminal acute ACL rupture, 147
disc herniations effect, cruciate ligaments, 147
222 multi-ligamentous, 148
function of, 221 unhappy triad, 147
Intoeing, 252, 301 Krackow, 152
Intra-articular calcaneus Kyphosis, 286
fractures, 182
Intramedullary nailing, 146
Intramembranous ossification, 27, L
293 Langenskiöld classification, 298
Intraoperative periprosthetic Lapidus procedure, 180
femur fractures, 142 Lateral compression (LC), 215
Involucrum, 330 Lateral epicondylitis, see Tennis
Ipsilateral femoral neck fracture, elbow
145 Lateral femoral epicondyle, 171
Iselin’s disease, 263 Lateral meniscus, 147, 174
Lateral subtalar dislocation,
block reduction, 10
J Lauge-Hansen classification, 184
Jahss technique, 98 LC-III injury, 216
Joint aspiration, 12 Leach of Henry, 72
Joint dislocation, 9 Leg length discrepancy, 303
Joint infection, 327 Legg-Calve-Perthes disease
Jones fracture, 192 crescent sign, 269
Jupiter classification system, 45 fragmentation, 269
Juvenile idiopathic arthritis, 341 MED, 269
Index 375
Waldenström stages of, 269 lunotriquetral, disruption of,

Letournal classification, 217 86
L5-S1 isthmic spondylolisthesis, Mayfield classification, 85
322 scapholunate ligament
Ligament vs. tendon, 4 disruption, 86
Ligament of Struthers, 72 Lupus rash, 354
Lightbulb sign, 32
Limb length discrepancy (LLD)
accurate assessment, 305, 306 M
classification, 305 Madelung’s deformity, 295
treatment, 306 Magnetic resonance imaging
Lisfranc fracture injury (MRI), 6, 12, 38, 73, 82,
articulations of Lisfrac joint 127, 131, 140, 161, 164,
complex, 189 175, 178, 182, 184, 203,
indication for ORIF, 189 206, 247, 311, 316, 320,
Lisfranc ligament, 189, 190 356
mechanism of, 189 Mallet finger deformity, 109
plantar ecchymosis sign, 189 Malunion, 8, 26, 40, 46, 62, 130,
Lisfranc/Lisfranc equivalent 131, 158, 186, 294
injuries, 191 Manske’s pulley, 80
Little Leaguer’s shoulder, 294 Mason classification, 49
Locking plates, 346 Mayfield classification, 85, 103
Long bone fracture, 14 Mean arterial pressure (MAP),
Longitudinal growth, 303 229
Loose bodies, 60 Mechanic’s hands, 361
Low back pain Mechanical lateral distal femoral
cause of, 235 angle (mLDFA), 300
differential diagnosis, 236 Medial collateral ligament
imaging for, 236 (MCL), 59, 147
risk factors, 235 Medial epicondylitis, see Golfer’s
Waddell signs, 236 elbow
Lower extremity trauma, 14 Medial meniscus injury, 147
Lubrication forms, 334 Medial parapatellar approach,
Ludloff osteotomy, 180 166
Lumbar disc herniation, red flag Medial patellafemoral ligament
symptoms, 12 (MPFL), 163
Lumbar lordosis, 239, 240 Medial proximal tibial angle
Lumbar spine conditions, see (MPTA), 300
Low back pain Meniscus tears
Lunate dislocation lateral, 150
arcs, 85 medial, 150
capitolunate articulation, vertical mattress sutures, 149
disruption of, 86 zones of, 149
emergency condition, 85 Metacarpal fractures, surgical
lateral wrist radiograph, 86 options, 98
376 Index
Metacarpal neck fractures, 98 operative management, 178

Metacarpophalangeal (MCP) physical exam, 178
joint, 98, 118 plantar surgical approach,
Metaphyseal corner fractures, disadvantages to, 211
267 radiographic method, 178
Metastatic disease, 241 Multiple epiphyseal dysplasia
Metastatic renal cell carcinoma, (MED), 269
242 Multiple hereditary exostosis
Metatarsal (MT) fracture (MHE), 358
conservative treatment, 191 Muscular dystrophy (MD), 314
dancer’s fracture, 192 Becker’s MD, 281
Jones fracture, 192 Duchenne’s MD, 281
Lisfranc/Lisfranc equivalent dystrophin protein, 281
injuries, 191 equinovarus foot deformity,
location of, 191 281
metabolic bone disease/ Gower’s sign, 281
amenorrhea, 191 x-linked recessive, 281
primary nonoperative Musculo-tendinous structure, 207
treatment?, 191 Myelodysplasia, see Spina bifida
Metatarsalgia Myositis, 362
causes of, 177
definition, 177
Morton’s neuroma, 177 N
location, 177 Necrotizing fasciitis, 124
management, 178 clinical physical exam signs,
radiographic method, 178 332
Metatarsus adductus, 310 immunosuppression, 331
Mid-shaft femur fracture, 146 mortality rate, 332
Milch classification system, 45 non-group A streptococci, 331
Mirror therapy, 122 origin, 332
Miserable malalignment polymicrobial, 331
syndrome, 163 rapid progression, 331
Mitchell osteotomy, 180 treatment, 332
Moberg flap, 100 Needle barbotage, 24
Monostatic disease, 352 Neer classification, 25
Monteggia fractures, 255 Nerve conduits, 112
classification system, 63 Nerve injury
outstretched arm in axonotmetic nerve injury, 112
hyperpronation, 64 categories of, 111
PIN injury, 64 connective tissue layers of
Morton neuroma nerve, 111
definition, 177 epineural repair, 112
intermetatarsal ligament, 211 grouped fascicular repair, 112
location for, 177, 211 growth of peripheral
nonoperative therapies, 211 nerve, 112
Index 377
neuropraxia and Oral glucocorticoids, 344

axonotmesis, 112 Orthopaedic terminology, 3
rule of 18, 113 Orthopedic emergency, 11, 328
water immersion testing, 112 Ortolani exam maneuver, 259
Neurofibromatosis, 314 Osgood-Schlatter’s disease, 263
type 1, 307 Os odontoideum, 320
Neurogenic claudication, 225 Osseous coalitions, 310
Neurogenic shock, 228, 323 Osteoarthritis
Neurologic level of injury, 323 chondroitin sulfate, 334
Neuromuscular scoliosis, 313, 314 deep and superficial
Neuropraxia, 111 laceration, 334
Neurotmesis, 111 keratin sulfate, 334
Neurovascular injuries, 40 lubrication forms, 334
Nightstick fracture, 62 normal aging, 333
Non weight bearing (NWB), 3 upper extremity
Nondisplaced distal radius Bouchard’s nodes, 57
fractures, 110 DIP joints, 57
Non-union, 8 Heberden nodes, 57
Notta’s node/nodule, 80 radiographic findings, 57
Nutritional markers, 314 symptoms of, 57
thumb CMC arthritis, 58
Osteoblastoma, 242, 243
O Osteochondral fractures/defects,
Odontoid fractures, 231, 320, 324 183
Olecranon apophyseal avulsion Osteochondroma, 242, 358
fracture, 265 Osteochondritis dissecans
Olecranon bursitis (OCD)
blood tests, 43 common location, 263
gram stain and culture, 43 Iselin’s disease, 263
non-painful, 43 Osgood-Schlatter’s disease,
sterile aspiration, 43 263
Olecranon fracture Sinding-Larsen Johansson
simple transverse olecranon syndrome, 263
fracture, 47 Osteogenesis imperfecta (OI)
treatment, 48 basilar invagination, 265
triceps tendon, 47 bisphosphonate therapy, 265
trochlea of the distal humerus, lower extremity deformity,
47 265
Open fractures, 4, 8, 11 type 1 collagen, 265
Open reduction and internal upper extremity fracture, 265
fixation (ORIF), 3, 50, Osteoid osteoma, 243, 357, 358
62, 98 Osteomalacia
bicondylar tibial plateau causes, 347
fractures, 174 clinical presentation, 348
Lisfranc fracture injury, 189 symptoms, 348
378 Index
Osteomyelitis Palmar aponeurosis pulley, 80

classification, 330 Panner’s disease, 294
diagnosis, 330 Parathyroid hormone, 348
inflammatory markers, 330 Parona’s space, 123
sickle cell patients, 329 Paronychia, 123
Staph aureus, 329 Pars interarticularis, 223
transmission, 329 Passively correctable deformity,
Osteonecrosis, 129 118
alcohol, 355 Patella
diagnosis, 356 blood supply, 159
differential diagnosis, 356 extensor mechanism, 159
of femoral head, 135 facets, 159
glucocorticoids, 355 Patellar dislocation
pathognomonic sign, 356 bony injury, 164
site, 355 risk factors, 163
surgical treatment, 356 sunrise view radiograph, 164
trauma, 355 TT-TG distance, 164
Osteoporosis, 129 Patellar fracture
bisphosphonates, 345 indications for nonoperative
locking plates, 346 treatment, 160
T-score, 345 mechanism of, 160
Osteosarcomas physical exam, 160
periosteal reaction, 360 surgical indications, 160
primary vs. secondary, 360 surgical options of fixation,
prognostic factor, 360 160
rapid bone turnover, 359 types of, 160
survival rates, 360 X-ray, 160
symptoms, 360 Patellar tendon, 151, 152
treatment, 360 rupture, 161
young adults, 359 Patellofemoral pain syndrome
Osteotomy, 4, 46, 58, 74, 140, 261, classification of
300, 356 chondromalacia, 169
Outtoeing, 251 first-line management, 169
pathology, 169
Pathognomonic sign, 356
P Pathological fracture, 8, 40
Paget’s disease of the bone Pediatric cervical spine disorders
(PDB) anterior translation, 320
clinical presentation, 351 basilar invagination, 320
imaging modality, 352 CT myelogram, 320
monostatic disease, 352 Os odontoideum, 320
neurologic complication, 352 pseudosubluxaton, 320
symptom, 351 rotary atlantoaxial
treatment days, 352 subluxation, 319
treatment of choice, 352 Pediatric fractures
typical atraumatic fracture, 351 clinical finding, 254
Index 379
Harris growth arrest line, 254 Phalangeal fractures

Salter-Harris I fractures, 254 apex dorsal, 93
Pediatric trigger thumb, 296 apex volar, 93
Pelvic incidence, 239 complication, 94
Pelvic instability, 14 distal phalanx, 93
Pelvic ring injuries, 216 operative indications, 94
APC-II and APC-III injury, Phosphate, 338, 347, 350
216 Pilon fractures
greater trochanters, 216 chaput fragment, 193
inlet X-ray view, 215 CT scan, 193
outlet X-ray view, 215 definition, 193
pelvic binder, 216 initial treatment, 193
posterior sacroiliac risk factor, 194
ligamentous complex, Volkmann fragment of the
215 distal tibia, 194
vertical shear, 216 Wagstaff fragment, 194
Young-Burgess classification, Plain X-rays, 5
215 Plantar ecchymosis sign, 189
Pencil-in-cup deformity, 117 Plantar fasciitis
Perilunate dislocation Baxter’s nerve, 209
arcs, 85 cast/boot immobilization, 210
carpal bone fracture, 85 chronic, 210
capitolunate articulation, first line of treatment, 209
disruption of, 86 medial tuberosity of
emergency condition, 85 calcaneus, 209
lateral wrist radiograph, 86 risk factors, 209
lunotriquetral, disruption of, 86 symptoms, 209
Mayfield classification, 85 Polio, 314
scapholunate ligament Polymicrobial infections, 331
disruption, 86 Polymyalgia rheumatic (PMR)
Peripheral neuropathy, 197 age of onset, 343
Periprosthetic femur fracture, 143 laboratory findings, 343
Periprosthetic fractures, 167 steroids, 344
Peroneal branch of sciatic nerve, symptoms, 343
142 treatment, 344
Peroneal tendons Polymyositis, 361
Charcot-Marie Tooth, 205 Ponseti casting method, 310
fleck sign, 205 Popeye deformity, 38
injury, imaging study, 206 Popliteal artery injury, 148
mechanism of peroneal injury, Post-axial and pre-axial
206 polydactyly, 295
pain, posterior lateral ankle, 205 Posterior cruciate ligament
pathology, 183 (PCL) tear, 148
peroneus brevis, 206 Posterior interosseous nerve
provocative test, 205 (PIN), 72
SPR, 205 injury, 64
380 Index
Posterior sacroiliac ligamentous surgical neck, 25

complex, 215, 216 surgical options, 26
posterior stabilizing implant, 168 X-ray views, 25
Posterior talofibular ligament Proximal humerus fracture, 346
(PFL), 183 Proximal interphalangeal (PIP)
Posterior tibial tendon, 10 joint, 78, 119
Post-operative periprosthetic Proximal interphalangeal (PIP)
femur fractures, 142 joint dislocation, 95, 96
Postoperative wound infections, dorsal, 95
245 Swan neck deformity, 95
Posttraumatic arthritis of the treatment, 96
elbow volar plate and at least
imaging modality, 59 one collateral ligament,
location for osteophytes, 60 95
MCL, 59 rotary, 96
nerve complication of volar
ulnohumeral Boutonniere deformity, 96
arthroplasty, 60 central slip and at least
ROM, 59 one collateral ligament,
test, 59 95
total elbow arthroplasty, 60 treatment, 96
Pre-axial polydactyly, 295 Proximal radioulnar joints, 55
Primary sleep disorders, 340 Proximal row carpectomy (PRC),
Progressive kyphosis, 234 74, 120
Pronator quadratus, 64 Proximal tibia lateral opening
Pronator syndrome wedge osteotomy, 300
diagnosis, 72 Proximal tibia physis, 303, 305
median nerve, 71 Pseudogout, 338
sites of compression, 72 Psoriatic arthritis, 341
Proximal femur fracture pencil-in-cup deformity, 117
characteristics, 131 vs. RA, 118
clinical finding, 129
imaging study, 130
mechanism of injury, 129 Q
MRI scan, 131 Quadriceps tendon rupture, 151
position of malunions, 131 complications, 162
predisposing factor, 129 radiographic finding, 162
surgical treatment, 130 risk factors for, 162
treatment for, 130 treatment for acute or
Proximal humeral fractures chronic, 162
blood supply to humeral
head, 25
complications, 26 R
nonoperative management, Rachitic rosary, 348
26 Radial club hand, 296
parts, 25 Radial head dislocations
Index 381
asymptomatic congenital, Renal osteodystrophy, 350

treatment for, 255 Replantation
Bado classification scheme, cold ischemia, 115
255 indications, 115
elbow extension/forearm mechanism of injury, 115
supination, 256 multiple digit, 116
Monteggia fracture, 255 warm ischemia, 115
radiocapitellar line, 256 Resuscitation, 13
Radial head fractures Rett syndrome, 314
aspirate elbow hematoma and Reverse hamburger
inject lidocaine, 50 sign, 232
classification, 49 Reverse total shoulder
early ROM to avoid elbow arthroplasty, 20, 33
stiffness, 50 Revision finger amputation
elbow fully extended and absorbable monofilament, 99
forearm pronated arm, cold intolerance, 99
49 complication, 100
Essex-Lopresti injury, 49 composite graft technique, 99
fragments, 50 mechanism of a lumbrical
PIN, 50 plus finger, 100
safe zones for ORIF, 50 Moberg flap, 100
surgical treatment options, 50 transverse or dorsal oblique,
vs. fragment excision, 50 99
Radial shaft fracture Rheumatoid arthritis (RA), 34,
complications, 62 55, 56
Volar approach of Henry and C1–C2 subluxation, 335
dorsal (Thompson) diagnostic serologies, 335
approach, 62 DIP joints, 335
Radial tunnel syndrome Felty’s syndrome, 336
PIN, 72 fixed deformity, 118
sites of compression, 72 inflammatory erosive synovial
Radiocapitellar arthritis, 60 tissue, 335
Radiocapitellar joints, 55 MCP joints, 118
Radiographic densities, 6 passively correctable
Radiology, 5–6 deformity, 118
Radius fracture rheumatoid nodules, 336
ipsilateral elbow and wrist swan neck and boutonniere
radiographs, 61 deformities, 335
restoration of the radial bow, treatment options, 118
62 vs. psoriatic arthritis, 118
Sugartong, 61 Rheumatoid factor, 335
Reactive arthritis, 341 Rheumatoid nodules, 336
Reflex sympathetic Rickets, 347, 348
dystrophy, 356 Rigid flat foot, 310
Regan and Morrey Rockwood classification, 29
classification, 51 Rolando fracture, 87
382 Index
Rotary atlantoaxial Septic arthritis

subluxation, 319 classic presentation, 327
Rotator cuff deficiency, 33 classic workup, 328
Rotator cuff tendons definition, 327
Hornblower’s sign, 20 definitive treatment, 328
subscapularis insertion, 19 IV drug users, 328
symptom, 20 mechanisms, 327
teres minor, 19 Staph aureus, 327
treatment for patients, 20 symptoms, 328
Septic joint
consequence, 12
S joint aspiration, 12
Sacroiliitis, 342 Sequestrum, 330
Salter-Harris type 1 injury, 254, Seronegative
324 spondyloarthropathies
Sanders classification, 182, 188 definition, 341
Scaphoid fracture genetic marker, 342
cause of, 82 manifestations, 342
CT scan or MRI, 82 radiographic spine features,
implants, 82 342
lunate bone, 81 treatment, 342
nonunion of a scaphoid, 82 Serum marker value, 13
physical exam, 82 Shopping cart sign, 226
proximal pole scaphoid Shoulder dislocation, 9
fracture, 81 Sickle cell disease, 355
SNAC wrist, 81 Silicon metacarpophalangeal
waist fracture, 81 (MCP) joint
Scaphoid nonunion advanced replacement, 34
collapse (SNAC) Sinding-Larsen Johansson
wrist), 81, 119 syndrome, 263
Scapho-lunate advanced collapse Skier’s thumb
(SLAC) wrist, 119, 120 adductor pollicus aponeurosis,
Scapholunate ligament tear, 103 89
Scapulothoracic dissociation, 14 definition, 89
Scarf osteotomy, 180 imaging, 90
Schatzker classification, 173 mechanism of injury, 90
Scheuermann’s kyphosis, 317 operative indications, 90
Schmorl nodes, 317 Stener lesion, 89
Sciatic nerve, 138 Skin lesion, 267
Scoliosis, 272, 317 Slipped capital femoral epiphysis
Seat belt injuries, 233 (SCFE)
Secondary hyperparathyroidism, classification, 257
350 Klein’s line, 258
Semmes-Weinstein obligate external rotation
monofilament sign, 258
testing, 200 radiographic view, 258
Index 383
risk factors, 257 Staphylococcus aureus, 246

treatment, 258 types of, 245
unstable, 257 vertebral osteomyelitis, 247
Smith-Petersen approach, 138 Spine tumors
Smiths fracture, 65 adjuvant treatment, 242
Soft tissue injury, 154 benign, 242
Spina bifida, 314 chordoma, 243
alpha-fetoprotein test, 275 conditions, 241
folate supplementation, 275 histological features, 243
L4, 275 metastatic disease, 241
latex allergy, 275 metastatic spine
rapid scoliosis curve lesions, 242
progression, 276 osteoid osteoma/
type II Arnold-Chiari osteoblastoma, 243
malformation, 275 primary malignant,
X-rays, 276 242, 243
Spinal abnormalities, 316, 348 Takuhashi scoring
Spinal cord injury (SCI) system, 242
anterior cord injury, 229 Spondylolisthesis, 321, 322
ASIA grades, 228 Hamstring tightness, 224
Brown-Sequard syndrome, isthmic, 224
229 types of, 224
cervical central stenosis/ Spondylolysis, 317, 321
spondylosis, 229 clinical presentation, 223
cervical spine fractures, 231 Hamstring tightness, 224
level of, 228 incidence of, 224
MAP, 229 X-ray findings, 223
neurogenic shock, 228 Spondyloptosis, 321
physical exam, 228 Spontaneous
spinothalamic tract, 227 osteonecrosis of knee
Spinal epidural abscess, 245–247 (SONK), 356
Spinal intradural infections, 245 Sprain, definition of, 4
Spinal muscular atrophy, 314 Sprengel’s deformity, 294
Spinal shock, 228, 323 Spring ligament, 207
Spinal stenosis, 236, 286 Spur sign, 218
definition, 225 Stable intertrochanteric
L5 nerve root, 226 fracture, 130
neurogenic claudication, 225 Staphylococcal aureus, 43
shopping cart sign, 226 Static encephalopathy, 271
vascular claudication, 226 Steinberg classification, 140
Spine deformity, 284 Stenosing tenosynovitis, see
Spine infections Trigger finger
imaging study, 247 Steroids, 24, 58, 122, 139, 162, 195,
Pseudomonas, 246 211, 337, 344
risk factors for, 246 Strain, definition of, 4
spinal epidural abscess, 246, 247 Streeter’s syndrome, 296
384 Index
Stress fractures, 6 T
bisphosphonate Takuhashi scoring system, 242
medication, 176 Talar neck fractures
in female athlete, 176 canale view, 185
higher risk for, 176 extruded talus, 185
lower extremity, 176 Hawkins classification, 185
MRI, 175 Hawkins sign, 186
pain, 175 lateral process, 185
site for, 176 mechanism of, 185
Subfibular impingment, 208 varus talar malunion, 186
Subtalar joint, 213 Talocalcaneal coalitions, 310
Subtrochanteric femur Talo-calcaneal joint, 213
fracture, 176 Tarsal coalition, 202, 207, 310
Subtrochanteric fracture, 131 Tarsal tunnel, 181
Superiomedial calcaneonavicular borders of, 201
ligament, 207 syndrome
Superior labrum anterior to causes of, 202
posterior (SLAP) clinical findings, 202
tears conservative treatment,
anterior labrum, 36 203
overhead throwing athletes, Dorsiflexion-eversion test,
36 202
surgical pitfall, 36 electrodiagnostic testing, 203
by Tuoheti classification, 35 MRI, 203
Superior peroneal retinaculum surgical decompression of
(SPR), 205 tibial nerve, 203
Supracondylar humerus fracture triple compression test,
malunion, 294 202
Suprascapular nerve Tendon vs. ligament, 4
compression, 71 Tennis elbow
Suprascapular nerve ECRB, 41
entrapment, 71 findings on examination, 41
Swan neck, 118 histopathology of, 41
Swan neck deformity, 95, 335 non-traumatic condition, 41
Sympathectomy, 122 treatment, 42
Sympathetic nerve block, 121 Terrible triad injury, 51, 147
Syndesmotic injury, 183, 184 Tethered cord, 276, 310
Synovitis, 177 Thermography, 121
Systemic lupus erythematosus Thompson test, 195
(SLE) Thoracic kyphosis, 233, 317
antibodies, 353 Thoracolumbar fractures, 233, 234
child-bearing age, 353 Thoracolumbar Injury
corticosteroids, 354 Classification and
definition, 353 Severity Score
hydroxychloroquine, 354 (TLICS), 234
hypercoagulable state, 354 Thrombocytopenia absent radius
SLE-related arthropathy, 117 (TAR) syndrome, 296
Index 385
Thumb carpal-metacarpal components, 141

(CMC) joint direct anterior approach, 142
arthritis, 58 direction of hip dislocation,
arthroplasty, 34 143
OA, 120 heterotopic ossification
Thumb duplications, 296 prevention, 143
Thumb metacarpophalangeal hip extension and external
(MCP) joint, 119 rotation, 143
Tibia shaft fractures hip flexion and internal
advantages of intramedullary rotation, 143
nailing, 155 intraoperative periprosthetic
closed reduction, 153 femur fractures, 142
complication, 154 peroneal branch of sciatic
diagnosis of compartment nerve, 142
syndrome, 154 posterior/posterolateral
Gustilo-Anderson approach, 142
classification, 154 posterior-superior zone, 143
LEAP study, 154 post-operative periprosthetic
procurvatum (apex anterior) femur fractures, 142
and valgus, 153 risk of dislocation, 143
techniques, 154 Vancouver classification, 142
treatment, 155 Total knee arthroplasty (TKA),
Tibial nerve, 201–203 3, 167
Tibial plateau fractures causes of failure, 167
Ankle-Brachial Index, 173 constrained and
compartment syndrome, 174 unconstrained implant,
CT scan, 174 168
joint alignment and stability, constrained implants, 168
174 cruciate retaining implant,
knee dislocation, 173 168
knee-spanning external femoral and tibial
fixation, 174 components, 166
lateral and medial plating, 174 flexion/extension gaps, 167
Lateral meniscus, 174 gap balancing, 166
Schatzker classification, 173 lateral compartment, 166
Tibial torsion, 163, 251, 252, 299, measured resection, 166
301 patient with history of, 167
Tinel’s sign, 18, 112 periprosthetic fractures, 167
Total elbow arthroplasty, 34, 60 posterior stabilizing
absolute contraindications, 56 implant, 168
complication, 56 simple primary, 166
indication for, 56 unconstrained implants, 168
Total hip arthroplasty (THA), 3 with medial approach, 166
acetabulum, Total shoulder
cup placement, 142 arthroplasty, 33
bone in-growth fixation, 142 Total wrist arthroplasty, 34
cement fixation, 142 Trabecular microfractures, 175
386 Index
Transcaphoid perilunate Tuoheti classification, 35

dislocation, 85 Type II Arnold-Chiari
Transient osteoporosis of hip malformation, 275
(TOH), 356 Type 2 fracture, 231
Transverse atlantal ligament
(TAL), 231
Trapezial body fractures, 84 U
Trapezial ridge fractures, 84 Ulna shaft fracture
Trapezium fractures, types of, 84 complications, 62
Trauma, 13–14, 355 ipsilateral elbow and wrist
Traumatic digit amputations, see radiographs, 61
Revision finger nonoperative treatment, 62
amputation restoration of the radial bow,
Traumatic lower extremity injury, 62
11 sugartong, 61
Traumatic paralysis, 314 Ulnar collateral ligament (UCL),
Traumatic unilateral shoulder 89
dislocations (TUBS), Ulnar nerve, 43
31 decompression, 70
Trendelenburg gait, 127, 265 transposition, 70
Triangular fibrocartilage complex Ulnar neuropathy, 60
(TFCC) tears, 17, 66 Ulnohumeral arthroplasty, 60
classifications, 102 Ulnotrochlear joints, 55
components, 101 Unhappy triad injury, 147
diagnosis, 102 Unstable intertrochanteric
imaging study, 102 fracture, 130
surgical options, 102 Upper extremity arthroplasty
symptoms and physical exam, MCP joint replacement, 34
101 reverse total shoulder
X-ray views, 101 arthroplasty, 33
Trigger finger thumb CMC arthritis, 34
medical conditions, 80 total elbow arthroplasty, 34
nonsurgical method, 80 total shoulder arthroplasty, 33
Notta’s node/nodule, 80 total wrist arthroplasty, 34
palmar aponeurosis pulley, 80 Upper extremity dislocation,
pediatric, 79 type of, 9
radial digital nerve to the Upper extremity physical exam
thumb, 80 anterior interosseous nerve,
symptoms, 79 18
Triple compression test, 202 cubital tunnel syndrome, 18
Triquetrum fracture De Quervain’s tenosynovitis,
fracture mechanism, 83 17
treatment, 84 Durkan’s carpal compression
Trisomy 21, 289 test, 18
Trochlear dysplasia, 163 glenoid labrum, 17
TT-TG distance, 164 supination, 17
Index 387
TFCC, 17 W
ulnar artery and radial artery, Waddell signs, 236
17 Wagner ulcer scale, 198
Uveitis, 342 Wagstaff fragment, 194
Warm complex regional pain
syndrome, 121
V Warm ischemia, 115
VACTERL association, 296, 315 Wassel classification, 296
Valgus, definition of, 4 Water immersion
Vancouver classification, 142 testing, 112
Varus, definition of, 4 Weight bearing as tolerated
Vascular claudication, 226 (WBRT), 3
VATER syndrome, 289, 296 Windswept pelvis, 216
Vertebral compression fracture,
234, 346
Vertebral osteomyelitis, 245, 247 X
Vertical shear (VS), 215, 216 X-ray, 5, 6, 14, 25, 62, 87, 101, 103,
Vitamin D, 347 160, 165, 178, 185, 186,
Volar approach of Henry and 205, 215, 217, 223, 247,
dorsal (Thompson) 254, 300, 321, 324, 348,
approach, 62 356
Volar intercalated segmental
instability (VISI), 103
Volar plate, 10 Y
V-Y flap, 99 Young-Burgess classification, 215

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Adam E. M.

ISBN 978-3-319-78386-4 ISBN 978-3-319-78387-1 (eBook)

Library of Congress Control Number: 2018943261

© Springer International Publishing AG, part of Springer Nature 2018

Printed on acid-free paper

This Springer imprint is published by the registered company Springer

To Denise and my boys,

For Ashley, always.

The book is the ideal, on-the-spot reference for students

Providence, RI, USA Adam E. M. Eltorai

Part I The Basics

11 Proximal Humeral Fracture. . . . . . . . . . . . . . . . . . . . 25

26 Degenerative Joint Disease of the Elbow . . . . . . . . 55

41 Lunate and Perilunate Dislocations. . . . . . . . . . . . . 85

56 Degenerative Arthritis of the Hand and Wrist . . . . 119

71 Patellar Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

86 Metatarsal Fracture. . . . . . . . . . . . . . . . . . . . . . . . . . . 191

101 Spinal Stenosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

116 Osteogenesis Imperfecta (OI). . . . . . . . . . . . . . . . . . 265

132 Axial Rotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

146 Necrotizing Fasciitis. . . . . . . . . . . . . . . . . . . . . . . . . . . 331

160 Malignant Bone Tumors. . . . . . . . . . . . . . . . . . . . . . . 359

Laura Amorese-O’Connell, MD The Warren Alpert Medical

Joanne Szczygiel Cunha, MD Division of Rheumatology,

Jonathan Hodax, MD, MS Department of Orthopedics,

Janake Patel, MD Roger William Medical Center, Boston

Andrew D. Sobel, MD Department of Orthopedics, Warren

American Academy of Orthopaedic Surgery. AAOS—OrthoInfo:

© Springer International Publishing AG, part of Springer Nature 2018 3

What is a systematic approach ABCS

© Springer International Publishing AG, part of Springer Nature 2018 5

 hat fracture segment

© Springer International Publishing AG, part of Springer Nature 2018 7

What is a feared long-term Post-traumatic arthritis

J. Babu, MD, MHA

© Springer International Publishing AG, part of Springer Nature 2018 9

What should be urgently Open reduction if closed

J. Babu, MD, MHA

© Springer International Publishing AG, part of Springer Nature 2018 11

What class of shock and what Class II Shock and loss of

J. Babu, MD, MHA

© Springer International Publishing AG, part of Springer Nature 2018 13

What structure is likely affected in a The Triangular

© Springer International Publishing AG, part of Springer Nature 2018 17

What is the most sensitive physical Durkan’s carpal

How many rotator cuff tendons Four

© Springer International Publishing AG, part of Springer Nature 2018 19

Majority of tears include which Supraspinatus, infraspinatus

Which structure in the shoulder is Joint capsule

© Springer International Publishing AG, part of Springer Nature 2018 21

What is calcific tendinitis? Calcification and tendon deposition

© Springer International Publishing AG, part of Springer Nature 2018 23

What X-ray views are Trauma series: true AP, axillary

© Springer International Publishing AG, part of Springer Nature 2018 25

How is the clavicle formed in Intramembranous ossification

© Springer International Publishing AG, part of Springer Nature 2018 27

How are AC By the Rockwood classification

© Springer International Publishing AG, part of Springer Nature 2018 29

Is anterior or posterior Anterior

© Springer International Publishing AG, part of Springer Nature 2018 31

Total shoulder arthroplasty is Rotator cuff deficiency

© Springer International Publishing AG, part of Springer Nature 2018 33

How are SLAP tears By the Tuoheti classification

Providence, RI, USA Adam E. M. Eltorai

Part I The Basics

11 Proximal Humeral Fracture. . . . . . . . . . . . . . . . . . . . 25

26 Degenerative Joint Disease of the Elbow . . . . . . . . 55

41 Lunate and Perilunate Dislocations. . . . . . . . . . . . . 85

56 Degenerative Arthritis of the Hand and Wrist . . . . 119

71 Patellar Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

86 Metatarsal Fracture. . . . . . . . . . . . . . . . . . . . . . . . . . . 191

101 Spinal Stenosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

116 Osteogenesis Imperfecta (OI). . . . . . . . . . . . . . . . . . 265

132 Axial Rotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

146 Necrotizing Fasciitis. . . . . . . . . . . . . . . . . . . . . . . . . . . 331

160 Malignant Bone Tumors. . . . . . . . . . . . . . . . . . . . . . . 359

hat fracture segment