References: Orthobullet, AAOS, miller Review, netter’s & Schwartz's

Aisha Mousa (R2 resident- Madina)

Anatomy and
Approaches
1. The nerve most at risk during single incision repair of the distal biceps tendon
rupture is lateral antebrachial cutaneous nerve
2. The most commonly involved structure in lateral epicondylitis ! ECRB
3. The best starting point for femoral IMN Insertion in 15 years old boy is just
lateral to the tip of the GT to avoid AVN
4. Weakness in raising arm above head: Injury to the spinal accessory N. (Trapezius)
5. Injury to the radial N. at the wrist cause sensory loss on the dorsal side of the 2nd
finger
6. Trendelenburg sign ! paralyzed hip abductors (G. medius and minimus –
superior gluteal N)
When standing on the affected site, fall of the hip in the opposite site
7. Nervous system is derived from Ectoderm
8. Injury to the tensor fasciae latae ! inability to flex and medially rotate the thigh
during running and climbing (Thigh ! medial rotation flexion abd, Leg ! Lateral rotation)
9. Most brachial plexus birth palsy recover by the age of 18 Ms
10. The primary function of the posterior oblique ligament is to resist the valgus &
External rotation of the knee between 0-30 degrees of flexion
11. During distal humerus medial approach OR ulnar N decompression, Be aware of
the posterior branch of the medial antebrachial nerve as it crosses the field 3 cm
distal to medial epicondyle
12. Composite or hybrid Ms are the Muscles which have more than one set of fibers
but perform the same function:
• Adductor magnus
• Pectinus
• Iliopsoas
• Biceps femoris
• Quadriceps Femoris
• FDP
13. Ms supplied by C5-C6 nerve root:
• Biceps (elbow flexion & forearm supination)
• Brachilais (elbow flexion)
• ECRL + ECRB (wrist extension) - C6
14. Gluteus Maximus: thigh extension + Assist in Thigh lateral Rotation
15. Hip extensors ! G. maximus & hamstrings (SemiT, SemiM, long head of biceps
femoris)
16. Epiphysio-diaphyseal joint is primary cartilaginous
17. The transverse Arch of the foot is maintained by: Adductor hallucis
18. Pain felt between 1st and 2nd toe is due to the involvment of L5 nerve root
19. In the posterior thigh, the sciatic nerve lies between gluteus maximus and
adductor magnus
20. AIN is the most common nerve injury with extension type supracondylar fracture
21. DeQuervain's syndrome ! tenosynovitis of the first dorsal compatment (APL &
EPB)
22. Intersection syndrome ! tenosynovitis of the 2nd dorsal compartments (ECRL,
ECRB)
23. Rupture of the terminal extensor tendon ! Mallet finger
24. Avulsion of the FDP ! Jersey finger
25. Rupture of the central slip of the extensor tendon ! Boutonniere Deformity (PIP
flexion with DIP extension )
26. In shoulder posterior approach, the radial nerve is well protected by Teres major
27. In dorsal thompson approach to the radius, the internervous plane is ECRB & ED
Proximally, ECRB & EPL distally
28. In volar Henry approach of the forearm, the internervous plane is BR & PT
proximally, BR & FCR distally
29. Triceps tendon attaches to olecranon
30. Structures involved in shoulder abduction:
• Supraspinatus (suprascapular N.), initiates the first 15 degrees
• Deltoid (axillary nerve), 15-90 degrees
• Trapezius (spinal accessory N.), 90-180 degrees
• Serratus anterior (long thoracic N.), 90-180 degrees
31. Brachialis inserted into ulnar tuberosity while biceps into radial tuberosity
32. Long head of the Biceps is inserted into supraglenoid tubercle while long head of
triceps is inserted into Infraglenoid tubercle of the scapula
33. 70% of shoulders have a posterior attatchment of the long head of biceps onto the
glenoid
34. Brachialis flex the forearm in ALL positions
35. Bicps flex the forearm when its supinated
36. All elbow flexors supplied by the median n. except the deep flexors (FPL, PQ,
lateral part of the FDP) supplied by AIN
37. The radial nerve enters the anterior compartment of the arm 10 cm proximal to the
radiocapitellar joint.
38. The axillary N. nerve is 6 cm Distal to the acromion process
39. Pubofemoral ligament ! prevents hyperextension of the hip
40. Superficial radial N. passes Deep to the BR & radial to the artery at the wrist
41. Dorsal scaphid branch supplies 75% of the scaphoid (proximal part)
42. The roof of the cubital tunnel is made up of Osborne's ligament, and the floor
consists of the medial collateral ligament.
43. Intrensic muscles supplied by Ulnar Nerve:
PB, Interossei, adductor policis & the deep head of the flexor policis brevis
 Basic science
1. Conevntional plate osteosynthesis (CPO) use causes greater compromise of
periosteal and medullary blood supply
2. Single forearm crutch (lofstrand) bears almost half of the body weight
• Single Axillary crutch bears 80% of the body weight
• Double axillary crutches bear 100% of the body wieght
3. Intermittent PTH (forteo): Anabolic (used in the ttt of osteoporosis)
Continuos PTH secretion: Catabolic
4. Ca phosphate & caroline hydroxyapatite are reabsorbed slowly within 1-10 years
Ca Sulphate reabsorbed quickly within 4-12 weeks
Combination of Ca phosphate and suphate result in Quicker reabsorption than
phosphate but slower than sulphate
5. Difference between Nutritional and hypophosphatemic rickets ! PTH level,
In nutritional rickets PTH level is increased while in Hypophosphatemic rickets
it’s normal
6. Mechanism of actions:
• Rivaroxaban (xarelto) ! direct Factor 10 inhibitor
• Fondaparinux ! Indirect Factor 10 inhibitor
• Warfarin (Coumadin) ! vit k Inhibitor (epoxide reductase inhibitor)
inhibiting the carboxylation & prevent vit k dependet factors (2,7,9,10)
protein C and S
• Anakinra ! IL-1 Antagonist
• Adalimumab and etanercept ! TNF alpha inhibitors
• Quinolones ! bacterial DNA gyrase inhibitor

7. Phenytoin increase the risk of osteoporosis and non-truamatic hip fractures

(Decrease the liver hydroxylation of vit D)
8. Virchows triad:
• Endothelial injury
• Venous stasis
• Hypercoagulability
9. Alkaptonuria ! ochronosis
10. Scurvy affects the primary spongiosa layer of the growth plate
11. For adults over the age of 50 RDA of 1200-1500 mg of Ca & 800 -1000 IU of
VitD
12. Long term bisphosphonates use can lead to subtrochanteric fractures which can be
seen in X-rays as lateral corical thickening
13. IgM is the first class of antibodies arise in our serum after exposure to an antigen
14. IgA is the most abundant in secretions
15. Confidence interval: the estimated range of values which likely include the
unknown parameters under investigations
16. Recombinant PTH (forteo) has been demonstrated to cause Osteosarcoma in
Animals
17.

18. Mesenchymal stem cell are multipotent stem cells that form: Muscle, fat, tendon
(fibroblasts), bone, cartliage BUT they dont form osteoclasts (formed from
monocytes)
19. The superficial tangential zone of cartilage ! contain progenitor cells
20. Anisotropic materials are those which behave differently dependent on the direction
of applied force
21. Modes of Bone healing:
Primary bone healing (AKA haversian remodeling OR intremembranous healing)
• Strain < 2%
• Occurs with rigid fixation: compression plates
Secondary bone healing (enchondral healing)
• Occurs with non-rigid fixation: fracture brace, Ex fix, IMN, bridge plating
22. Hypertrophic nonunions are caused by inadequate stability
Oligotrophic nonunions are caused by lack of biology (poor blood supply)
23. The level of evidence:
• Level 1: High quality RCT
• Level 2: Low Qulaity RCT or prospective cohort
• Level 3: Retrospective cohort or Case control
• Level 4: Case series
• Level 5: Case report OR expert articles
24. Body controlled prosthesis require more harnessing compares to myoelectric
prosthesis (harness ring placed at C7)
25. Salter Harris type 1 fractures occurs in Hypertrophic Calcification zone
26. The combinations of Methotrexate and Tetracyclins are more effective in the
treatment of RA (Tetracyclins inhibit the collagenase enzyme which is involved
in the breakdown of the macromolecules contributing to the pathological changes
of the RA)
27. CaCl and thrombin have stimulatory effect on platelet
28. Postoperative UTI treatment ! 3-5 days of single antibiotic
29. PMN are the first cells to migrate into the wound (the first 24-48 hours)
30. Peak number of fibroblasts in healing wounds ! 6 days after the injury
31. Arginine ! improve the wound healing
32. Vit A ! promotes wound healing in Patients receiving steroids
33. Too far Inset prostheic foot will produce: VARUS strain, Pain (distal/lateral and
proximal/medial) at the socket and circumducted gait
Too far Outset prosthetic foot will produce: VALGUS strain, pain (distal/medial
and proximal/lateral) and broad-based gait
34. Anticipation is a phenomenon where symptoms of genetic disorders become
apparent at an earlier age as its passed to the next generation.
35. Doxorubicin most serious side effect ! Cardiac toxicity
36. Hx of bleeding disorder (GI bleeding, Von willebrand Ds, Hemorrhagic stroke,
Hemophilia) Classify the patient as having elevated risk of MAJOR BLEEDING
37. Hx of hypercoagulable state (such as protien C deficincy) classify the patient as
having elevated Risk of PE
38. Factors inhibit Osteoclastogenesis:
• Osteoprotegrin (OPG)
• Calcitonin
• Bisphosphonates
• Denosumab (monoclonal antibody)
39. Vit C administration following wrist fracture lowers the risk of complex regional
pain syndrome.
40. The use of recombinant erythropoietin (EPO) preoperatively associated with a
higher incidence of DVT
41. Lead toxicity Affects the growth by inhibiting PTHrP
42. Osteoblasts realease RANKL Binds to its receptor RANK on Osteoclast precursor
! Osteaoclasts realease cathepsin K at the ruffeled border ! bone resosption
43. The Power is the ability of a study to detct the difference between 2 interventions
and its defined by 1- probability of type II (beta) error
44. LMWH was found to have an increased level of postoperative hematoma when
compared to aspirin, clopidogrel and compression devices.
45. The distance of a bone traversed by screw is called: the working length
46. Genetic imprinting: the allele that is expressed is dtermined on which parent
contributes it
47. The duration and the speed of the Ms contraction depends on the type of the Ms
fibers
48. The amount of maximal tension/force of contraction dependens on the cross
sectional area of the Ms
49. As the human body ages, the thickness of the bone cortex DECREASE and the
medullary canal INCREASE
50. The primary mode of bisphosphonate excretion is Renal
51. The tibia is subjected to internal rotation during knee flexion
52. The lateral femoral condyles moves posteriorly on the tibia when the knee flexes
from 0-120 degrees while the medial femoral condyles remain stationary. Beyond
120 degrees both condyles participate in the femoral rollback
53. A material undergoing plastic deformation will not return to its original form
once the stress is removed. (This occurs when a material has been subject to stress
past the yield strength or point). Prior to the yield point, Elastic deformation
occurs.
54. Amount of energy a material can absorb before failure is called toughness
55. Osteoprotegrin (OPG) is a decoy binds to the RANKL preventing its binding to
RANK receptor on osteoclasts preventing Osteoclast stimulation
56. Stress shielding: decrease in the physiological stress in bone due to stiffer
structure sharing load.
57. Wolff's low: bone remodels in response to mechanical stress
58. When steroids injected extra-articularly it doesn’t cause myocytes apoptosis.
59. Entanercept was found to increase the rate of infection post-operatively in patients
with rheumatoid arthritis.
60. Traumatic amputations increase the metabolic demands of walking less than those
performed for vascular causes.
61. Epigenetic changes: defined as inheretible genetic alterations that dont involve
DNA mutations.
62. Bisphosphonates are divided into:
• Nitrogen containing: acts by inhibiting farnesyl diphosphate synthase
• Non-nitrogen containing: acts by metabolizing it into non-functioning
ATP which will cause osteoclasts apoptosis.
63. Osteosarcoma has a mutation in Rb gene
64. The DEEP zone of the articular cartilage has the HIGHEST concentration of
proteoglycans and LOWEST concentrations of water
65. Locked plating reduces the interfragmentary strain more than conventional
plating.
66. Vaughn-jackson syndrome rupture of the hand extensor tendons which occurs
from the ulnar side of the wrist then moves radially (EDM is the first tendon
ruptured) Frequency ! EDM > ED (ring) > EDC (small) > EPL
67. Mannerfelt syndrome: Rupture of the FPL (in RA patient)
68. Type IV delayed hypersensitivity reaction occurs with palte and screws
69. The specificity is the probability that a test will be negative in patients without
disease measuring true negatives divided by the sum of true negatives & false
positive
70. During surgical dissection, the molecules that is found to be involved in DVT
formation 3 days post-operatively is Thromboplastin
71. Neutrohils are the first to appear in acute muscle injury
72. History of a prior vertebral fragility fracture is the strongest predictor of future
fragility fracture
73. Compressive strength are provided by Proteoglycans & Ca hydroxyapatite
74. Tensile strength is provided by type 1 collagen
75. Sclerostin is an osteocyte derived negative regulator of the Wnt signaling in
osteoblasts leading to decrease the bone mass.
76. Tranexamic acid ! competitive inhibitor of plasminogen activation
(Anti-fibrinolytic that promotes and stabilizes the clot formation)
77. Ca sulfate bone graft substitute ! increases the serous fluid at the surgical site
78. Calcium phosphate and sulphate have a low tensile and shear stress
79. Regarding the frame stiffness, pin diameter has the greatest influence on the
stability of the unilateral frames
80. For more stable construct:
• Decreasing the distance between the rod and the bone
• Increase the number of the connecting rods
• Increase the diameter of the pins
81. Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease of the
motor neuron system. Electrodiagnostic studies (nerve conduction & EMG) are
required for a definitive diagnosis
82. ACL has the biomechanical properties of viscoelasticity, Creep, stress relaxation
83. All ligaments and tendons are anisotropic and exhibit different mechanical
properties depending on the direction of the applied load
84. Creep: constant loading cause the material to continue to deform over time
85. Stress relaxation whereby stress will be reduced under constant deformation
86. The sclerotome of the somite develops into Axial skeleton:
• The neural crest ! peripheral nervous system
• The lateral plate ! dermis
• The dorsal myotome (epimere) ! dorsal muscles
87. Dynamic compression plates achieve compression through eccentric placement of
the screw (ideal for transverse fracture).
88. Type II errors (false negative) is accepting the null hypothesis when its in fact Not
Ture)
89. The positive predictive value is defined as the true positives divided by the sum of
all positives (true & False positives)
90. The orientation of chondrocytes and collagen fibrils in the superficial zone of
the articular cartilage is: parallel to the tidemark in order to resist the sheer and
compressive forces
91. Core binding factor Alpha (cbfa1) is the key transcription factor associated with
osteoblasts differentiation
92. The effect of bisphosphonate in spinal fusion surgery ! DECREASE the rate of
fusion
93. Chronic use of alendronate ! Osteonecrosis of the jaw
94. Rifampin acts synergistically well with other antibiotics because of its high
cellular penetration
95. Type I collagen is found in:
• Bone
• Ligaments
• Tendons
• Menisci
• Scar tissue
• Nerves
• Fibrocartilage
• Annulus fibrosis of intervretebral disc
96. Type II collagen is found in:
• Articular (hyaline) cartilage
• Nucleus pulposus of the intervertebral disc
97. Perichondrial artery is The major blood supply t the Growth plate
98. Ceramic has Low fracture toughness, Low tensile strength & poor crack
resistance BUT shows the BEST wear if combined with Polyethylene as in THA
99. Ceramic has the highest modulus of elasticity between materials
100. The tensile strength of the viscoelastic material is affected by the Rate of the
force
101. Peri-operative anticoagulation management (AAOS):
• Stop warfarin 5 days preop
• Start bridging therapy (LMWH)
• Stop LMWH 12-24 Hour pre-op
• Resume LMWH once homeostasis has been achieved (6 Hours Post-op)
• Restart warfarin at the patient’s usual dose at the same time.
102. RDA of Ca:
• Lactating women ! 2000 mg/d
• Pregnant, healing fracture or menopause ! 1500 mg/d
• Adolescent ! 1300 mg/day
• Adults ! 750 mg/d
103. Changes in articular cartilage with Age:
INCREASE in SOCR All other factors are decreased
• S: stiffness (modulus of elasticity)
• O: protein
• C: chondrocyte size
• R: ratio of keratin sulphate to chondroitin sulphate
 Foot and ankle
1. The first-line treatment of chrcot neuropathy is always total contact casting for a
two to four months followed by the use of a CROW boot (charcot restrained
orthotic walker)
2. Cheilectomy relieves dorsal impingement pain associated with Grade 1-2 MTP
arthritis
3. Surgical correction of the mild and moderate deformities of the MP joints :
Metatarsophalangeal joint capsular release, tightening of collateral ligaments,
tendon lengthening, and flexor tendon transfers.
4. Surgical correction of the severe deformities of the MCP Joints with subluxation
or dislocation ! Shortening osteotomies
5. Stage II posterior tendon Insufficiency (flexible deformity) : calcaneal osteotomy,
FDL transfer, and lateral column lengthening.
Stage III posterior tendon insufficiency (fixed deformity) wih subtalar and
midfoot arthritis: triple arthrodesis (fusion of calcaneocuboid, talonavicular, and
subtalar joints).
6. Resection of the lateral sesamoid in hallux valgus correction can lead to Halux
varus
7. Stage IV arthritic talotibial ankle or talar tilt: pantalar fusion
8. The most common physical finding in patients who have had a cerebrovascular
accident is spastic equinovarus deformity of the foot and ankle from an upper
motor neuron.
• Equinus ! overactivity of the gastrocnemius-soleus complex
(ttt: lengthening of the Achilles tendon)
• Varus ! overactivity of the tibialis anterior.
(ttt: split anterior tibialis tendon transfer (SPLATT)
9. Most of the plantar aspect of the foot derives its sensory innervation from the
plantar nerves, which are the terminal sensory branches of the tibial nerve.
Lateral plantar nerve innervates the abductor digiti quinti and travels across the
heel, just anterior to the medial tuberosity of the calcaneus.
10. The main ankle stabilizer during stance phase ! deltoid ligament
11. Plantarfelxion opening wedge medial cuneiform osteotomy (cotton ostoeotmy) is
an adjunvtive procedcure used to correct the residual forefoot varus component.
12. Phase of gait affected most in patient with Quadriceps atrophy ! Midstance
13. Stance phase:
• Heel strike ! TA contracts Eccentrically
• Foot flat ! GS contracts Eccentrically
• Toe off !GS contracts Concentrically
14. The primary antagonist of the Tibialis anterior ! Peroneus longus
 Hand
1. Claw hand deformity characterized by MCP hyperextension and IP joint flexion.
Imbalance between strong extrinsics and deficient intrinsics is the pathoanatomic
process of a claw hand (AKA intrinsic minus hand deformity)
2. In a hand with ulnar neuropathy, adductor pollicis (ulnar n.) is deficient, and cannot
flex the MCP joint. The thumb compensates by recruiting the FPL (median n.) to flex
the IP joint.
3. Froment's sign is performed by having the patient pinch a piece of paper with the
thumb IP joint extended against resistance (pulling paper away). It should be done
with both hands side by side to compare them to each other.
3. The deep plamar arch is formed by ! Radial A. + Deep palmar branch of ulnar A.
4. The superficial palmar arch is formed by ! Ulnar A. + superficial branch of radial A.
5. Temporary scaphotrapeziotrapezoidal (STT) pinning is indicated for treatment of
Kienbocks disease when there is increased density and slight lunate collapse.
6. The pattern of force transmission across the joint:
• Neutral wrist: ! via the lunate fossa and scaphoid fossa equally (slight
predominance to the scaphoid fossa).
• Extended wrist ! via the scaphoid fossa.
7. Wrist-proximal amputations should be performed:
• < 12 hours of cold ischemia time
• < 6 hours of warm ischemia time
8. In digital amputations, replantation should be in the following sequence:
Bone! extensor tendons ! flexor tendons ! arteries ! nerves ! veins (can be done
prior to nerve repair) ! skin.
9. Following digital replantation, if arterial insufficiency develops: release constrictive
bandages, place the extremity in a dependent position, consider heparinization,
consider stellate ganglion blockade, or explore early if these maneuvers do not work.
10. Arterial thrombosis after digit replantation typically occurs within the first 12 hours
postoperatively whereas venous thrombosis/congestion occurs after the first 12 hours
postoperatively.
11. Leeches excrete Hirudin, which is 100 times more potent than heparin, but are
typically used for the treatment of venous thrombosis/congestion and not arterial
thrombosis.
12. In transverse proximal phalanx fracture the apex palmar angulated deformity is due to
the indirect pull of the central slip on the distal fragment and the interossei insertions
at the base of the proximal phalanx.
13. Semmes weinstein testing ! the most sensitive sensory test for detecting early CTS
14. Durkan’s test (compression test) ! the most sensitive test to detect CTS
15. Self administered hand diagram ! the most specific test for CTS
16. The median nerve sits immediately ulnar to FCR. The median nerve injury is most
likely to be associated with a deep laceration of flexor carpi radialis (FCR) at the
level of the wrist.
 Oncology
1. SCARE are tumors that metastasize to the LN:
• S: synovial sarcoma
• C: clear cell sarcoma
• A: Alveolar sarcoma, angiosarcoma
• R: rhabdomyosarcoma
• E: Epthelioid sarcoma
2. The most common site for bone Metastasis ! Spine
3. The most common benign bone tumor in childhood ! non ossifying fibroma
4. The most common site for pathological fracture ! proximal femur
5. Cotton wall appearance of the skull ! Pagets disease
6. Most common soft Tissue sarcoma in adults ! Fibrous histiocytoma
7. The 2nd most ommon soft tissue sarcoma in adults ! liposarcoma
8. The most common malignant soft tissue sarcoma in children: rhabdomyosarcoma
9. The Most common sarcoma in the foot: Synovial sarcoma
10. The Most common sarcoma in the hand: epithelioid sarcoma
11. The most common primary tumor in Bone: MM
104. The most common translocations:
• Clear cell sarcoma t(12;22)
• Alveolar rhabdomyosarcoma t(2:13)
• Synovial sarcoma t(x:18)
• Ewings sracoma t(11:22)
12. Aneurysmal bone cyst:
• Pain and swelling
• Distal femur & proximal tibia
• Eccentric lesion
• Can cross the physis
13. Unicameral bone cyst:
• Pain and pathological fracture
• Proximal humerus & proximal femur
• Centric lesion
• Doesn’t expand beyond the physis
14. Osteoid osteoma of the spine will result in painful scoliosis CONCAVE ON THE
SIDE of the lesion.
 Spine
1. C6 radiculopathy:
• Weakness of brachioradialis (elbow flexion weakness)
• ECRL weakness (wrist extension weakness)
• Sensory changes in the thumb
• Diminished brachioradialis reflex.
2. C7 radiculopathy:
• Decreased triceps reflexes
• Weakness of elbow extension
• Weakness of wrist flexion
• Paresthesias of the index and middle finger.
3. In the cervical spine the nerve root travels ABOVE the corresponding pedicle
4. In the lumbar spine it travels BELOW the corresponding pedicle.
5. In the cervical nerve root, both a central and foraminal disc affect the same nerve
root. (Horizontal Anatomy)
6. In the lumbar spine due to the descending path of the nerve root (vertical
anatomy) a paracentral and foraminal (far lateral) disc often affect different nerve
roots. (Paracentral will affect the nerve of the lower vertebra & the foraminal will
affect the nerve of the upper)
7. Signs of myelopathy:
• Inability to preform a tandem gait
• Intrinsic wasting
• Positive Hoffmann's sign
• Finger escape sign (the two ulnar digits drift into abduction and flexion
within 30 seconds).
46. Pesudoarthrosis following anterior cervical discectomy and fusion (ACDF) is
treated with posterior cervical fusion due to its increased fusion rate and lower
revision surgery rate.
8. Recurrent laryngeal nerve injury is treated with obseravtion for 6 weeks if
persistant send to ENT
9. Spondylolysis is an anatomic defect in pars interarticularis (radiolucent gap)
10. Spondylolisthesis is a forward translation of one vertebral segment over the one
beneath it
11. 15% of individuals with a pars interarticularis lesion have progression
(spondylolisthesis)
12. Degenerative spondylolisthesis is caused by intervertebral disc degeneration, facet
joint degeneration and sagittal orientation ligamentous laxity. In adults it usually
occurs at L4/5. It is more common in African Americans, diabetics, and women
over 40 years of age. The first line of treatment should be nonoperative. If this
fails decompression and instrumented fusion is indicated.
13. There are 2 types of spondylolisthesis in children - dysplastic and isthmic.
14. Isthmic spondylolithesis is classically seen in gymnasts, football players and other
athletes who do a lot of repetitive hyperextension activities. It can be classified as
Low Grade or High Grade. Most patients with Low Grade spondylithesis can be
treated with non-operative treatment that involves PT and activity modification.
15. Initial treatment of osteoporotic compression fractures without neurologic
compromise consists of pain control, progressive increase in activity levels &
TLSO. If pain continues after 6 weeks of non-operative therapy ! kyphoplasty.
If a neurologic deficit is present ! surgical decompression and stabilization.
15. If PLL is intact (even if > 30 degrees kyphosis or > 50% loss of vertebral body
height) ! conservative management alone is Enough
16. If PLL is injured ! surgical decompression should be done
17. In spondylosis, AP and lateral radiographs demonstrate 80% of defects, and
oblique radiographs demonstrate 15% of defects.
18. Single photon emission computed tomography (SPECT) is the most sensitive
imaging modality to diagnose spondylolysis when AP and lateral radiographs are
normal.
19. L4 radiculopathy:
• Weakness in ankle dorsiflexion
• Quadriceps weakness (unable to go from a sitting position to a standing
position)
• Decreased patellar reflex
20. Bilateral resection of the inferior articular process will destabilize the spine.
21. Spurling test ! consistent with the diagnosis of cervical radiculopathy
22. Shoulder abduction test is specific for the diagnosis of cervical radiculopathy
(improvement of symptoms with elevation of the arm above head: positive test)
23. L5 radiculpathy:
• Weakness in ankle dorsiflexion
• Weakness in Hip abduction (gluteus medius)
• Weakness in Great toe extension (EHL)
24. Congenital scoliosis is caused by anatomic anomalies of the vertebral bodies. it
can be divided into failure of formation (hemivertebrae, wedge vertebrae,
butterfly vertebrae) and failure of segmentation (block vertebrae, bar body).
25. Failure of formation with contralateral failure of segmentation (hemivertebrae
with a contralateral bar body) has the worst prognosis and is an indication for
surgery.
26. The difference between spinal & neurogenic shock ! Absent bulbocavernous
reflex in spinal shock
27. A Trendelenburg gait is caused by gluteus medius weakness. Gluteus medius is
innervated by L5.
28. Congenital muscular torticollis (CMT) is the most common cause of torticollis in
infancy.
29. Ultrasonography is the modality of choice for differentiating (CMT) from other
more serious pathologies in the neck when a palpable mass is present.
30. The initial treatment of CMT is conservative, and good outcomes can be expected
in the majority of these cases.
 31. Patients with ankylosing spondylitis are prone to spinal fracture due to their rigid
spine & the vertebral bony anatomy makes them vulnerable to epidural bleeding.
32. The most common fracture pattern in ankylosing spondylitis ! extension-type
fractures of the cervicothoracic junction.
33. In Ankylosing spondylitis, the ttt of patient who has a progressive neurological
deficit and radiographic evidence of compression ! surgical decompression -
wether posterior or anterior- & laminectomy should be done as it’s the treatment
of choice.
34. Degenerative Spondylolisthesis most commnly occurs at the level of L4-L5
35. Degenerative spondylolisthesis of the cervical spine occur at the level of: C3/C4
36. Adult spondylolisthesis most commonly occurs at the level of L5-S1
37. Pain with single-limb standing lumbar extension ! characteristic finding in
spondylosis
38. At L4 spondylosis and above: treatment includes pars interarticularis repair
39. At L5-S1 spondylosis: treatment is fusion with bone grafting.
40. Signs of the neural compromise ! Gill procedure is indicated (a wide, bilateral
decompression of the neural elements with removal of the loose lamina)
41. Spondylolisthesis ttt ! Combined anterior/posterior fusion
42. 75% of people have the artery of adamkiewicz on the left side between T9 and
T11
43. S1 nerve root injury:
• Weakness in plantar flexion
• Decreased achilles reflex (gastroc+ soleus)
44. S2 nerve root injury: diminished perianal sensation
45. Anterior iliac crest bone graft harvest ! Risk of injury to the ilioinguinal Nerve +
lateral femoral cutaneous N.
46. Posterior iliac crest bone harvest ! Risk of superior gluteal Artery + cluneal N
34. Hangmans fracture:

Levine and Edwards Classification (based on mechanism of injury)

• < 3mm horizontal displacement

Type I • No angulation
• C2/3 disc remains intact Rigid cervical collar 4-6 weeks
• Stable fx pattern

• > 3mm of horizontal • If < 5mm displacement than reduction

displacement
Type II • Significant angulation
• Vertical fracture line
• C2/3 disc and PLL are disrupted
• Unstable fracture pattern
with traction then halo immobilization
for 6-12 weeks.
• If > 5mm displacement consider
surgery or prolonged traction.
• Usually heal despite displacement
(autofuse C2 on C3).
 • No horizontal displacement • Avoid Traction in Type IIA.
Type IIA • minimal translation • Reduction with hyperextension then halo
• Horizontal fracture line immobilization for 6-12 weeks.
• Severe angulation

• Type I fracture with associated

Surgical reduction of facet dislocation
Type III bilateral C2-3 facet dislocation
followed by stabilization required.
• Rare injury pattern

35. T4 has the smallest pedicle diameter OVERALL, T1 has the largest
36. L1 has the smallest pedicle in LUMBER spine
37. Colon Tumors rarely metastasize to the spine
38. Pedicles of the thoracic spine has the highest ratio of cortical to cancellous bone
39. Normal Thoracic kyphosis ! 20-50 degrees
40. Approximately 20% of the vertical load is borne by the posterior structures of the
lumber spine
41. Sclerotome ! axial skeleton
42. The spine is formed from the 3 elements of the embryonic plate:
• ECtoderm ! spinal Cord & nervous system
• ENdoderm ! Notochord ! Nucleus pulposus
• MeSoderm ! Ms and bony elements
43. Two somites are involved in the formation of the thoracolumber spine
44. The normal thoracic & lumbar vertebra are comprised of one main anterior
ossification center & two posterior centers
45. The recommended doses of methylprednisolone for spinal cord injury:
• < 3 hours ! initial bolus of 30 mg/kg over 1 hour, followed by an infusion of
5.4 mg/kg/h for an additional 23 hours.
• 3-8 hours: continue infusion up to 48
• > 8 hours old ! the methylprednisolone is not recommended

ASIA Impairment Scale

A Complete No motor or sensory function is preserved in the sacral segments S4-S5.

B Incomplete Sensory function preserved but No motor function is preserved below the neurological
level and includes the sacral segments S4-S5.

C Incomplete Motor function is preserved below the neurological level, and more than half of key
muscles below the neurological level have a muscle grade less than 3.

D Incomplete Motor function is preserved below the neurological level, and at least half of key muscles
below the neurological level have a muscle grade of 3 or more.

E Normal Motor and sensory functions are normal.

47. Interleukin 1 beta stimulate the production of the matrix metalloprotinase, nitric
oxide, interleukin6, PGE2 from Intervertebral discs
48. During aging of the intervertebral disc: The ratio of keratin sulphate to
chondroitin sulphate INCREASE
49. AS patients who underwent THR through posterior kocher approach is at risk of
Anterior Hip dislocation
50. Central cord syndrome:
• Elderly patient
• Extension injury
• Upper extremity weakness
• Spared perianal sensation
• Lower extremity spasticity
51. Compression deformity of less than 50% and kyphosis of less than 30°: TLSO
extension brace.
52. The spinal nerves in cauda equina primarily responsible for bladder function!
S2, S3, S4
53. In flexion injury of the spine, dislocation is common at the level of C5/C6
54. The tumor biology, location, and pretreatment neurologic status are the best
predictors of a patient's postoperative neurologic prognosis.
55. Preexisting kyphosis is a contraindication to laminectomy (because the cord is
unable to float posteriorly away from the anterior compression, and the risk for increasing
kyphosis is significant)
56. Subluxation in patients with RA is most likely to occur at the level of C1/C2
57. Osteopenia has the most effect on the pullout strength of the lumbar transpedicle
screw fixation
58. Patient with complete spinal cord injury, an anterior decompression can gain an
additional level of root function.
59. The Sympathetic chain approaches the lateral border of the longus colli muscle at
C6 and is more vulnerable to injury at this level.
60. Os odontoideum is congenital or residual of a traumatic process.
• Asymptomatic patients ! cessation of contact sports alone
• Symptomatic or Wide ADI (atlanto-dens interval): posterior C1-C2 fusion.
61. ADI > 3.5 mm considered unstable
62. In kyphotic deformity, Pedicle subtraction Osteotomy (PSO) allows the most
correction in the sagittal plane at a single level without having to resect the
intevertebral disc While Vertebral column restion (VCR) provide the greatest
amount of resection, but requires resection of the intervertebral disc.
63. The commonest level of Thoracic disk herniation ! T8-T12
64. Neurogenic claudication is relieved by sitting & walking UP hill (climbing stairs)
65. Vascular caludication relieved by standing still
66. The Risk of concomitant cervical spine injury in patients sustained facial fractures
after involving in MVA ! 10%
67. Spinal motion segment is made up of a disc with its adjacent vertebrae & their
interlocking facet joints devoid of Musculature
68. The typical anterior approach to the cervical spine uses the plane between the
carotid sheath LATERALLY - trachea and esophagus MEDIALLY
69. Potts disease typically gets at the level of T12-L1
70. Any degree of thoracolumbar kyphosis is considered ABNORMAL
71. The normal adult width of the canal ! 17 mm
72. Impingement (canal stenosis) begins at 13 mm, signs of myelopathy appear at 10
mm
73. Disc pressure is HIGHEST with setting & leaning forward LOWEST on laying
on the back
74. When the cervical spine moves from neutral to full flexion, the spinal cord
undergoes plastic deformation & the spinal canal lengthen.
75. Anterior cord syndrome has the worst prognosis in spinal cord injury
 Trauma
1. Maintenance of mechanical axis correlates most with a satisfactory clinical
outcome when managing an intra-articular fracture of the proximal tibia.
2. Tibial diaphyseal hypertrophic nonunions ! exchange reamed nailing.
3. Pelvic & Acetabular imaging:
Outlet view:
• Superior inferior translation of the hemipelvis,
• Flexion extension translation of hemipelvis
• Visualization of the neural foramina
Inlet view:
• The anterior-posterior translation of the hemipelvis
• Internal external rotation of the hemipelvis
• Widening of sacroiliac joint
Inlet iliac oblique view: AP position of screw within the pubic ramus
Obturator oblique: to Rule out joint penetration
Obturator obliq. Inlet view: position of a supraacetabular screw within the ilium
The lateral sacral view: the sagittal curvature of the sacral ala, possible iatrogenic
L5 nerve injury.
Judet veiw (obturator): anterior column + posterior wall
Judet veiw (iliac): posterior column + anterior wall
4. Regarding Humerus IM nails distal interlocking screws:
• Anterior-to-posterior screws ! musculocutaneous nerve at high risk
• Lateral-to-medial screws ! radial nerve at high risk
5. Wound healing is based on several factors include:
• Ankle brachial index (ABI) > 0.45
• Lymphocyte count > 1500/mm3
• Serum albumin > 3.0 g/dl
6. Double arc sign ! fracture of the distal articular surface of the humerus
(capitellum and part of the trochlea)
7. The safest ankle casting position regarding compartment pressure ! 0-37 degrees
of plantar flexion
8. POP'S IQ: nerves exiting below piriformis are: Pudendal, Obturator internus,
Postfemoral cutaneous, Sciatic, Inferior gluteal, Quadratus femoris
9. In pelvic ring injuries:
• APC has the highest rate of vascular injury
• LC has the highest rate of head injury
10. Humerus nonunions -both diaphyseal and proximal locations- achieve union with
plate fixation and bone grafting
11. Os acetabuli marginalis superior is a benign accessory ossification center found in
the superior aspect of the acetabulum
12. Corona mortis is the anastomosis between external iliac artery or inferior
epigastric artery with obturator artery. High Risk of injury during the Stoppa or
ilioinguinal approach to the pelvis.
13. To decrease the pressure on the sciatic nerve ! hip extension & knee flexion
14. The center of rotation of angulation (CORA) in diaphyseal tibial deformity:
The intersection of the proximal mechanical (PMA) or anatomical axis(PAA), and
the distal mechanical(DMA) or anatomical axis(DAA).
15. Subtalar arthritis is the most common complication of talus fracture
16. Some intraoperative techniques to avoid valgus deformity of the tibia are:
• Reduction with unicortical plates/clamps
• Semi-extended nailing
• Suprapatellar nailing
• Usage of a more lateral starting point
• Usage of an external fixator or femoral distractor
17. The Most common risk factor of humerus non union ! VitD deficiency
18. MESS: (The score that used to asses the need for amputation)
Score of 7 or more is highly predictive of amputation
1. Skeletal / soft-tissue injury:
• Low energy = 1
• Medium energy = 2
• High energy = 3
• Very high energy = 4
2. Limb ischemia:
• Pulse reduced or absent but perfusion normal = 1
• Pulseless = 2
• Cool, paralyzed, insensate = 3
3. Shock:
• Normotensive = 0
• Transient hypotension = 1
• Persistent hypotension = 2
4. Age:
• < 30 = 0
• 30-50 = 1
• >50 = 2.
19. Return to braking:
• 6 weeks after weight bearing initiation In long bone & periarticular
fractures
• 9 weeks following ankle joint fixation
20. Anterior knee pain is the most common complication following tibia IMN
21. GSWs are a contraindication for spinal dose steroids.
22. In displaced ipsilateral femoral neck and shaft fractures, Fixation with a single
implant has the highest rate of fracture malreduction.
23. Findings that suggest a pre-ganglionic brachial plexus lesion include:
• Horner syndrome (ptosis, miosis, anhidrosis)
• Medially winged scapula
• Loss of paraspinal musculature activity on EMG
• Normal histamine test.
These injuries tend to have a worse prognosis than post-ganglionic lesions, which show
an abnormal histamine test and intact cervical paraspinal activity on EMG.
24. Non-displaced distal radius fracture treated conservatively maybe complicated by
delayed rupture of the EPL tendon, treatment with Extensor indicis transfer
25. In distal radius Fractures, FPL rupture is more common with volar plates.
26. Locked plates indications:
• Indirect fracture reduction
• Diaphyseal/metaphyseal fractures
• Osteoporotic bone
• Severely comminuted fractures.
27. Fixation of olecranon comminuted fractures ! Bridge plating
28. Fixation of severely comminuted olecranon in osteoporotic low-demand elderly
! Cast Immobilization in 90 degree of flexion OR olecranon fracture excision
and triceps advancement
29. Femur retrograde nailing has an INCREASED rate of symptomatic distal
interlocking screws, need for dynamization, longer union time, BUT less thigh
pain than antegrade nailing.
30. A delta P (preoperative diastolic blood pressure minus intraoperative
compartment pressure measurement) of < 30 mmHg is an indication for
fasciotomy
31. Structures at risk in CRPP of the proximal humerus:
• Proximal lateral pins → the anterior branch of the axillary nerve.
• Anterior pins → biceps tendon, cephalic vein, Musculocutaneous N
• Greater tuberosity pins → the posterior humeral circumflex A + the axillary N
34. The most common soft tissue injury with tibial plateau fractures ! Lateral
meniscus
35. The most common complication in proximal humerus fractures treated with
locking plates is screw cut out or penetration, followed by varus displacement.
36. In stable elbow dislocation, management include closed reduction, splinting or
sling placement for 5-7 days Then early ACTIVE ROM exercises
37. Optimal treatment of a comminuted radial head fracture with greater than three
fragments ! radial head replacement.
38. Pronation abduction injury result in: comminuted fibula fracture above the level
of syndesmosis
39. In DCO, trauma patient is classified as 'unstable' or 'in extremis', if he or she
meets the criteria in at least three of the four parameters
• Blood pressure <90mmHg
• Platelets count <70,000
• Temperature <32°C
• Major soft tissue injuries
40. Regarding proximal humerus fractures treated with hemiarthroplasty, the height
of the prosthesis & degree of retroversion is best determined by the superior
border of the pectoralis major insertion (PMI).
41. Pilon fracture splits into three main fragments at the joint level:
• Chaput fragment (anterolateral – attatched to Anterior inferior tibiofibular
ligament)
• Volkmann fragment (posterolateral- attatched to posterior inferior
tibiofibular ligament)
 • Medial fragment.
The Wagstaff fragment is the fibular corollary to the Chaput fragment serves as the
other attachment of the anterior inferior tibiofibular ligament.
42. When comparing antiglide (posterior) plating of the distal fibula and lateral
neutralization plating, posterior antiglide plating is associated with INCREASED
construct stiffness and strength, DECREASED hardware prominence, screw
penetration, improved biomechanical findings in osteoporotic bone BUT it is
associated with peroneal tendonitis and irritation.
43. Femoral intramedullary reaming debris has similar biochemical characteristics as
iliac crest autograft.
44. Chopart amputation: amputation of the foot at the level of the calcaneocuboid and
talonavicular level.
45. The Chopart amputation may result in significant equinovarus deformity.
Therefore, lengthening of the Achilles tendon and transfer of the tibialis anterior
to the talar neck should also be performed
46. The most common deformity after IMN of proximal tibia fractures: Valgus and
procurvatum
47. The most common deformity after IMN of Distal Tibia fractures: Malrotation
48. The complication of IMN following subtrochanteric femur fracture: Varus and
procurvatum (caused by the effect of hip abductors and iliopsoas)
49. The most common variation of a Hoffa fracture ! coronal fracture of the lateral
femoral condyle
50. Indomethacin increases the risk of long bone and acetabular nonunion.
51. Volume of saline needed in saline load test to diagnose 99% of Traumatic
arthrotomy ! 175 ml
52. Greater tuberosity malunion is a common complication of Shoulder
hemiartheroplasty and it causes loss of shoulder elevation
53. Shoulder impingement and re-operation are complications of IMN of the humerus
54. In ipsilateral femoral neck & shaft fractures ! 30% of the cases femoral neck
fractures will be missed
55. 75% of the radial head articulates with the ulna. The remaining 25% is considered
the "safe zone" and is important for placement of fixation.
56. Hawkins sign: subchondral lucency on mortise Xray 6-8 weeks following talar
neck fractures indicates intact vascularity with resorption of subchondral bone
57. The pelvic spur sign is indicative of a both column acetabular fracture. The spur is
the intact portion of the ilium, still attached to the axial skeleton and seen
posterosuperior to the displaced acetabulum
58. Indications of Operative fixation of humeral Fractures:
• Failure of closed reduction
• Associated articular injury
• Vascular or brachial plexus injuries
• Associated ipsilateral forearm fractures
• Segmental fractures
• Pathologic fractures.
59. The most common urological injury with AP pelvic ring injuries is posterior
urethral tear, followed by bladder rupture.
60. Preservation of Peroneus brevis insertion in lisfrank (tarsometatarsal) amputation
will prevent equinovarus deformity.
61. Lag screw with tip-apex distance >25 mm is associated with increased failure
rates
62. Medial subtalar dislocations are more common and blocked from closed reduction
by the extensor digitorum brevis & peroneal tendons.
63. Lateral subtalar dislocations are more likely to be open, have an associated
fracture, and are blocked from closed reduction by the posterior tibial tendon,
flexor digitorum longus, or flexor hallucis longus (medial structures)
64. The most common tarsal fracture associated with lateral subtalar dislocations is
the cuboid
65. Drill bit or screw that penetrates the posterior facet of the calcaneus can injures
the flexor hallucis longus as it runs just inferior to the sustentaculum tali on its
way to its insertion on the first phalanx of the great toe.
66. In Monteggia fractures the annular ligament is commonly interposed in the
radiocapitellar joint
67. In Galeazzi fracture if DRUJ is irreducible, suspect ECU interposition
68. Saphenous and sural arteries are the main blood supply to the proximal posterior
aspect of the calf in BKA
69. In syme amputation, patent tibialis posterior artery is required
70. A starting point slightly anterior to the piriformis fossa has the benefit of
improved placement of screws through the nail and into the femoral head
71. In treating tibial plateau split depression fractures, calcium phosphate has been
shown to have the least amount of articular subsidence due to its high
compressive strength.
72. In open tibial fractures ! Combination of IMN + BMP2 have better clinical
outcome
73. In case of tibia nonunion ! BMP7
74. Terrible triad injury:
• Radial head fracture
• Coronoid fracture
• Elbow dislocation
75. The key primary stabilizer in terrible triad is the lateral collateral ligament
complex, restraint to varus & posterolateral rotatory instability
76. Anterior bundle of the MCL of the elbow is the 2nd most important to stability,
restraint to valgus and posteromedial rotatory instability, inserts on sublime
tubercle (anteromedial facet of coronoid)
77. The most common complication of olecranon fracture treated with tension band
wiring is symptomatic implants due to subcutaneous nature of the olecranon.
78. Acetabular fracture with no articular surface in continuity with the remaining
posterior ilium ! Both columns acetabular Fracture
79. The most likely cause of the radial nerve palsy in open humerus fracture ! radial
nerve Neurotmesis (complete disruption)
80. Passive external rotation of the shoulder place the most stress on the lesser
tuberosity fixation
81. In ipsilateral neck and shaft femur fractures, Neck of femur should be reduced &
fixed first
82. In case of traumatic hip dislocation, look for a ipsilateral knee injury as the force
is usually transmitted to the hip joint through the knee
83. Ilioinguinal approach is used for direct visualization of both columns acetabular
fractures
84. Sequence of Ms. reinnervation following radial N. palsy:
BR, ECRL, supinator, ECRB, ED, ECU, EDM, APL, EPL, EPB, EI
85. Annular ligament interposition commonly occurs with Radial Head dislocation
86. The most reliable test to diagnose DVT (gold standard) ! venography (contrast
venogram)
87. To Asses Calcaneal Posterior facet/Middle facet fracture ! semicoronal CT
88. Best option is to assess stability of Syndesomsis intraoperatively:
abduction/external rotation stress of dorsiflexed foot
89. Instability of the syndesmosis is greatest in the anterior-posterior direction
90. In femoral Neck fractures: External rotation and Flexion of the involved extremity
is the position that result in the Highest intra-capsular volume Lowest intracpsular
pressure
91. In Schatzker II tibial plateau fracture, Joint widening more than 6mm suggests
lateral meniscal injury.
92. In terrible triad injury, Repair of LCL results in the greatest increase in elbow
rotatory stability
93. The most common mode of failure of the lateral ulnar collateral ligament
associated with elbow dislocation is avulsion of the humeral origin
94. Anteromedial coronoid facet fracture and LCL injury ! varus posteromedial
rotatory instability.
95. Forces applied to reduce the proximal fragment in Subtroch. Femur fractures !
Extension & internal rptation
96. Most common fracture in osteoporotic patients:
Vertebral body > Hip > distal radius
97. Treatment of low velocity gunshot injuries (< 2000 feet/sec) with non operative
fractures ! Irrigation & local wound care in ER followed by 3 days of oral ABx
98. The success rate of AVN treatment before collapse ! 86%
99. Important x-ray views:
• Medial epicondyle fracture ! axial view
• Lateral condyle fracture ! internal oblique
• Radial head/neck fracture ! Radiocapitellar view (greenspan)
 Pediatrics
1. The Kocher criteria for septic arthritis include:
• Fever>38.5 degrees centigrade (101.3 F) the most significant prognostic
parameter
• Inability to bear weight
• ESR>40 mm/h
• WBC>12,000/ul
• CRP > 2
2. Mutation in the gene encoding for Fibrillin! MarFan Syndrome
3. Defect in FGFR3: Achondroplasia (abnormal chondroid production in the zone of
proliferation of the physis.)
4. Bone Aspiration is required for definitive diagnosis in osteomyelitis
5. Defect in Type 1 collagen:
• Osteogenesis Imperfecta
• Ehlers Danlos syndrome
6. Charcot Marie tooth Ds: mutation in the gene PMP22 on the chromosome 17p12
7. Management of Cavovarus foot deformity associated with Charcot-Marie-Tooth
(CMT) disease depends on Coleman block test
• Normal block test: TIB posterior or peroneus longus tendon transfer
• Abnormal: calcaneo-valgus osteotomy
• Abnormal with arthritic changes: triple arthrodesis
8. Greenstick forearm fractures are usually supination injuries with apex-volar
angulation & can be reduced with forearm pronation
9. Medial epicondyle fracture displaced more than 5 mm ! ORIF
10. CAVE is the clinical picture and the order of deformity correction in Clubfoot
• C midfoot Cavus (corrected while forefoot in SUPINATION)
• A forefoot abduction
• V Hindfoot Varus
• E Hindfoot Equinus
11. Legg calve perthes disease prognosis & management depend on the age:
• < 6 years good prognosis
• < 8 years observation
• >8 osteotomy
12. Dural ectasia occurs with 60-90% of patients with Marfan syndrome
13. Block test is the best initial screening for LLD
14. CT scanography is the most accurate diagnostic test with contractures of the hip,
knee, or ankle
15. Neurofibromatosis is the most common cause of anterolateral tibial bowing
16. Highest risk of morbidity and mortality in pediatric trauma ! spine fracture
17. Osteopetrosis: mutation in carbonic anhydrase II, Mutation In chloride channels 7.
18. Crossed pin fixation of pediatric supacondylar fractures associated with a higher
rate of ulnar nerve injury
19. Skin lesions are the most common presentation of physical abuse followed by
fractures
20. In blounts disease, lateral physeal growth arrest with staples or plates occurs
by increasing compression forces across the physis which slows longitudinal
growth (Heuter-Volkman principle)
21. Pediatric proximal tibia metaphyseal fractures (Cozen fractures) often progress to
VALGUS deformity due to medial evergrowth. TTT of valgus ! observation
(self-limiting)
22. Management of stage 1, 2 Blount's disease in children < 3 years old: bracing with
KAFO
23. Indications for operative management in BB forearm fractures:
• Bayonet apposition (overlap) in children older than 10 years of age
• Angulation >15 degrees and rotation >45 degrees in children <10 years
• Angulation >10 degrees and rotation >30 degrees in children >10 years
• Open fracture
24. Tarsal coalition associated with peroneal spastic flatfoot leading to rigid pes
planus deformity of the foot.
25. Posteromedial bowing of the tibia and fibula associated with a calcaneovalgus
foot deformity.
26. The most common causative organism of neonatal septic arthritis ! Group B
Streptococcus
27. Hindfoot parallelism between the talus and calcaneus In X-rays: characteristic of
CTEV
28. Duchenne muscular dystrophy: complete absence of dystrophin
29. Beckers Muscular dystrophy: decreased dystrophin
30. Olecranon fractures in skeletally immature patients are pathognomonic of
Osteogenesis imperfecta.
31. Risk factors of DVT as a complication of osteomyelitis:
• CRP > 6
• Age >8
• MRSA
• Surgical drainage
32. To maximize the function in patients with CP: tendon transfer
33. Treatment of LLD is dictated by the length discrepancy at maturity (not at the
original presentation):
• <2cm: nonoperatively
• 2-5cm: epiphysiodesis of the normal limb
• >5cm: limb lengthening
34. Posteromedial tibial bowing ! thought to be a result of intrauterine positioning
35. Plantarflexion of the first ray is the initial deformity in CMT
36. Medial epicondyle fractures are the most common fractures patterns associated
with elbow dislocations
37. Dynamic supination following Ponseti treatment, managed by anterior tibial
tendon transfer to the lateral cuneiform (more common) and cuboid.
38. Proximal femoral resection is indicated in a nonambulatory patient with CP that
has pain while sitting in wheelchair.
39. Blounts Ds surgical management:
• Skeletelly immature pt ! lateral epiphysiodesis
• Skeletally mature pt ! otseotomy
40. Genu valgum in skseletally immature pt.: medial epipysiodesis

41. Spinal muscular atrophy (SMA is associated with the mutation in survival motor
neuron 1 (SMN1) gene
42. Tongue fasciculation + abscent deep tendon reflexes ! SMA
43. Gene mutation in cartilage oligometric matrix protein (COMP) ! multiple
epiphyseal dysplasia ( MEDCOMP)
44. Last to ossify in the elbow ! lateral epicondyle
45. Last to fuse in the elbow ! Medial epicondyle
46. Floating Elbow should be treated with CRPP
47. The posterior leaf spring ankle-foot orthosis (PLSO) ! absent heel strike,
minimal dorsiflexion, excessive ankle plantar flexion in the swing phase
48. Mucoploysacchridosis:
• Morquio syndrome
                                                  Type A galactosamine suphate suphatase deficiency
Type B beta galactosidase deficiency
No MR
Odontoid hypoplasia
Keratan sulphate in Urine
• Hurler Syndrome
alpha L-iduronidase deficiency
Dermatan sulphate in urine
Death
• Hunter
sulpho-iduronate sulphatase deficiency
Dermatan + heparan sulphate in urine
• San flippo
                                              Heparan sulphate in Urine
49. In properly reduced forearm fracture, the AP radiograph demonstrates the radial
styloid and biceps tuberosty 180 degrees apart
50. On the lateral view, the coronoid process and ulnar styloid will be 180 degrees
apart.
51. Distal humeral physeal separations in the infant or young child ! child abuse
52. Infantile osteopetrosis: AR
Adult Osteopetrosis: AD
53. Rugger jersey spine ! Osteopetrosis
54. Diastrophic dysplasia ! defect in sulphate transport protein due to mutation in
DTDST gene leading to failure of growth of epiphysis, hitchhikers thumb,
cauliflower ear
55. Toddlers fracture ! long leg cast
56. Initial treatment for symptomatic coalition ! immoblization and casting
57. Maximum displacement of the humerus lateral condyle fracture ! internal
oblique radiograph.
58. >2mm of displacement of lateral condyle of humerus on any view ! surgical
fixation.
59. Single transverse long bone fractures are the most common presenting fracture
pattern in abused children.

60. Hemimelia of the tibia with active quadriceps (knee extension): Syme amputation
61. Hemimelia of the tibia with No active knee extension: Knee disarticulation
62. To differentiate between the OM & bone infarcts:
Bone marrow scan is NORMAL in OM and DECREASED uptake in Bone
Infarct
63. In SCFE, indications of Pinning of the contralateral physis:
• Boys under 12 & girls under 10
• The presence of an open triradiate cartilage
• Evidence of an endocrinopathy
64. The Beighton-Horan scale ! used to evaluate patients with joint laxity & Ehlers-
Danlos syndrome.
65. Inferior lens dislocation is associated with homocystinuria while superior lens
dislocation is associated with Marfan syndrome
66. Dural ectasia: marfan syndrome & NF
67. In Monteggia Fracture, closed reduction and immobilization of the arm in 110
degrees of flexion and supination enhances the stability of the injury by tightening
the interosseous membrane and relaxing the biceps tendon
68. DDH in a patient with a closed triradiate cartilage ! peri-acetabular osteotomy
(Ganz)
69. True elbow dislocation will have disruption of the radiocapitellar line in lateral X-
ray while transphyseal separation of the distal humerus will not.
70. Timing  of  surgery  in  patients  with  Duchenne  muscular  dystrophy  is  based  on  the  
patient’s  pulmonary  and  cardiac  status  and  not  the  severity  of  scoliosis.
71. Tillaux fractures: Salter Harris III fracture of the distal tibial epiphysis
72. Rough estimation of weight: Age x 2 + 10
73. In the Ap pelvis of SCFE ! Klein’s line along the superior border of the femoral
neck will NOT intersect the head
74. Examination of DDH:
• < 3 Ms ! Barlow & ortolani
• > 3 Ms ! Hip Abduction test
75. Imaging in DDH:
• After ossification of the femoral head (4-6 months) ! Radiographs
• Before ossification of the femoral head (<4 Ms) ! US
76. TTT in DDH:
• < 6 Ms ! Pavlic harness for 4 wks
• 6-18 Ms ! CR & spica casting
• >18 Ms ! OR & spica casting
• 2-4 Yrs ! Femoral or pelvic osteotomy
77. Pt with JIA & positive ANA: high risk of iridocyclitits
 78. DDx of Frequent pediatric ankle sprains:
• CMT
• Tarsal coalition
79. Pediatric foot deformities:
• CMT: Cavovarus
• Tarsal coalition: flatfoot, hindfoot valgus, peroneal spasticity
80. Children with osteomyelitis allergic to Penicillin ! use Clindamycin OR
Vancomycin
81. The type of pelvic osteotomy that leaves the tear drop (medial wall) in its original
position is: Dial osteotomy
82. There are 4 independent predictors of Acute OM caused by MRSA:
• T > 38.0 C
• WBCS > 12000 cells/µL
• Hematocrit < 34%
• CRP > 13 mg/L
The  predicted  probability  of  MRSA  osteomyelitis  is  92%  if  all  4  Predictors  existed  
83. Fibular hemimelia: Anteromedial tibial bowing, absent lateral rays/toes, ACL
insufficiency.
Tibial hemimelia: insufficient extensor mechanism, clubfoot, cleft hands.
84. Daily calcium requirements for children are as follows:  
Age 1-3yrs - 500mg/d  
Age 4-8yrs - 800mg/d  
Age 9-18yrs - 1000 to 1500mg/d  
 
 
 Sport
1. Patient with Rotator cuff Rupture & shoulder arthropathy ! Reverse total
shoulder arthroplasty
2. The prevelance of Asymptomatic rotator cuff tears seen on MRI in patients over
the age of 60 ! 30-55%
3. External rotation lag sign ! Infraspinatus Tear
4. Hornblower sign ! Teres Minor dysfunction
5. Positive Jobe test ! Supraspinatus rupture
6. Positive lift off test ! Subscapularis Rupture
7. The average medial to lateral distance of supraspinatus tendon footprint on GT is
14-16 mm
8. Indication of Pectoralis major transfer ! subscapularis insufficiency
9. Hemiarthroplasty in shoulder arthropathy ! improve the pain only NOT the
function
10. Reverse shoulder arthroplasty ! improve pain and function
11. Reverse TSA require Functioning deltoid
12. TSA require functioning Rotator cuff
13. Anterior shoulder dislocation in young patients ! anteroinferior labral tear
14. Anterior shoulder dislocation in old pt. (>40 year) ! rotator cuff tear (up to 80%)
15. Patient with isolated Supraspinatus tear can proceed with TSA
16. Engaging of hill sachs lesion in 90/90 arm position ! means >25% engagement
! needs remplissage procedure (infraspinatus transfer)
17. Posterior shoulder instability Operative management:
• Open/arthroscopic repair of bankart !
Recurrant instability
Pain with axial loading
• Rapair + Subscapularis and Lesser tuberosity transfer !
< 6 Months duration
< 50% hill Sachs defect
• Hemiarthroplasty !
> 6 Ms
> 50% hill Sachs defect
18. For glenohumeral internal rotation deficit: posterior-inferior stretching exercises
19. The scapula rotates during cocking and acceleration to clear the acromion to
prevent impingement on the rotator cuff.
20. In throwing cycle: the most harmful phase is DECELRATION
21. Maximum ER occurs In LATE COCKING phase
22. Segond fracture (avulsion fracture of the proximal lateral tibia) is pathognomonic
for an ACL tear
23. Genotype within the COL5A1 gene is associated with reduced risk for ACL
ruptures in women
24. Adhesive capsulitis: fibroblastic proliferation
25. Iontophoresis: Transcutaneous delivery of medication with electrical current
26. Missed humeral avulsion of glenohumeral ligament (HAGL) can cause recurrant
dislocation following Bankart repair
27. The PCL is usually tensioned in 90-degree flexion and the ACL is tensioned in
extension.
28. In comparison to biceps tenotomy, Biceps tenodesis Decrease Arm cramping
29. Previous patellar instability carries the highest risk of persistent patellar instability
(Higher risk than increased Q angle)
LCL femoral insertion is PROXIMAL & POSTERIOR to the Popliteus insertion
(3Ps). At the fibula, it’s the the most anterior structure
30. Axial rotation at 50 degree of knee flexion will show the greatest difference
between normal and ACL deficient knee
31. Biceps femoris inserted posterior to The LCL on the fibular head
32. The popliteofibular ligament inserts medial to the LCL on the fibular head
(originates at the Musculotendinous junction of the popliteus)
33. Osteonecrosis in MRI ! Decrease signal intensity in subcondral region
34. Calcific tendinitis in MRI ! Hypointense area within the soft tissue around the
shoulder
35. Eccentric exercise cause delayed onset muscle soreness (DOMS)
36. Indications for latissimus dorsi tendon transfer:
• Young pt with irreparable posterosuperior rotator cuff tear
• Lack of glenohumeral arthritis
• Intact subscapularis function
• Active forward elevation
37. The medial UCL is subjected to near-failure tensile stresses during the late
cocking/early acceleration phase of throwing.
38. Adductor muscle avulsions are caused by muscle failure in tension as the leg is
abducted. Treatment: rest, ice, Rehabilitation and mobilization with protected
weight bearing are recommended to avoid muscle scarring and contractures.
39. The gold standard for diagnosis of a SLAP tear ! arthroscopy.
40. The False profile view is performed in patients with Femoroacetabular
impingement (the patient standing with the affected hip on the cassette, the pelvis
rotated 65° from the plane of the cassette)
41. In Grade III AC joint separation, surgery result in higher complication rate in
comparison to conservative management
42. To test the posterior instability of the shoulder: jerk test & kim test
43. Rotator cuff arthropathy: pesudoparalysis, joint effusion, anterosuperior escape of
the humeral head
44. Treatment of Rotator cuff arthropathy in low demand elderly ! Reverse TSA / in
young ! Hemiarthroplasty
45. Active knee flexion (hamstring contraction) is avoided in the immediate
postoperative period in PLC repair
46. During the deceleration phase of throwing in the overhead athlete, the rotator cuff
is the principal decelerator of the arm (susceptible to tensile failure due to
eccentric loading during this phase)
47. The most common cause of intrarticular loose body in the adult Knee ! OCD
48. Closing wedge HTO: Decreasing the slope ! Prevents Anterior translation of
tibia ! Indicated in ACL deficint knee
Opening wedge HTO: Increasing the slope ! prevents posterior translation of
tibia ! indicated in PCL deficint knee
49. Contents of rotator interval:
• Coracohumeral ligament
• Superior glenohumeral ligament
• Biceps tendon
50. The primary restraint to the lateral patellar translation in the first 20 degree of
Knee flexion ! MPFL
51. After arthroscopic rotator cuff surgery, early passive ROM has equivalent
functional outcomes when compared to 6 weeks of immobilization
52. Extensor digiti minimi rupture is asccoaited with rheumatoid degeneration of
DRUJ
53. The maximum acceptable divergence of the interference screw in the femoral
tunnel in ACL reconstruction before pull out strength is reduced ! 15 degrees (if
more than 15 degrees will result in loss of fixation)
 Arthroplasty
1. Increasing femoral off set will decrease the Bone on bone impeingement
2. In case of infected prosthesis:
• Poor health status or inadequate bone stock ! resection
arthroplasty
• Good health or adequate bone stock ! two stage revision
arthroplasty & 6 weeks of IV antibiotics
3. The most common complication following proximal tibial opening wedge
osteotomy ! Patella baja
4. The most common reason for secondary surgery following TKA !
patellar maltracking
5. Over resction of the posterior femoral condyles in posterior stabilized
TKA leads to flexion instability
6. Low toughness is a disadvantage of the ceramic bearings in total hip
arthroplasty
7. The optimal placement of acetabular cup is 45 degrees of abduction & 20
degrees anteversion
8. Increasing abduction angle ! increase wear rates
Decrease anteversion ! increase posterior hip dislocation
Increase anteversion ! increase impingement