Which of the following is most accurate about the etiology of her diagnosis? L5. 4/20/2020. What is the most appropriate course of action? Aiming the nail posteriorly in the proximal segment, Anterior blocking screw in the proximal segment, Medial blocking screw in the proximal segment. The upper three-quarters of the patella articulates with the femur and is subdivided into a medial and a lateral facet by a vertical ledge which varies in shape. An AP and lateral radiograph in extension are shown in Figures A and B respectively. The patient was referred to your office for a consultation. His symptoms have remained persistent and both he and his parents are concerned as this limits his performance. Which of the following hip positions would put the patient at the greatest risk for dislocation? Lateral blocking screws in proximal tibia fragment, Use of a radiolucent triangle to flex the knee, Anterior blocking screw in the proximal tibia fragment, Medial parapatellar arthrotomy avoiding the patellar tendon. What technical adjunct could have prevented the operative complication seen in Figure B? Copyright 2022 Lineage Medical, Inc. All rights reserved. (SAE07HK.26) What is the best course of action? Copyright 2022 Lineage Medical, Inc. All rights reserved. L3/4 central disc herniation with impingement on the bilateral descending nerve roots, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Spine | Lower Extremity Spine & Neuro Exam. Most commonly involves the medial meniscus, Asymptomatic discoid meniscus should undergo saucerization, Radiographs will commonly show a hyperplastic lateral intercondylar spine, Radiographs will commonly show squaring of affected condyle with cupping of tibial plateau. 698 plays. A radiograph is provided in Figure A. Copyright 2022 Lineage Medical, Inc. All rights reserved. A 23-year-old-male was involved in a motorcycle accident. findings. 5.0 (6) See More See Less. The retinacular fibres of the patella also stabilize it during exercise. It is pointed in shape, and gives attachment to the patellar ligament. Tibialis posterior (tibial n.) EHL (DPN), EDL (DPN) Hip dislocation. She has now dislocated posteriorly 3 times, each followed by closed reduction under anesthesia in the operating room. Treatment is closed reduction and casting or surgical fixation depending on the degree of displacement. Figure 27 shows the AP radiograph of a patient who has late instability. [citation needed]. Application of an anterior unicortical plate. (SBQ12SP.3) A 34-year-old male presents with a closed left leg injury after falling off a 20ft ladder. This is her third dislocation in the last 6 months. He complains of right leg pain, and physical exam reveals no evidence of an open fracture. You decide to treat this injury with an intramedullary nail. WebMedial parapatellar arthrotomy avoiding the patellar tendon. Anatomy. may show spur at inferior pole of patella. [9] In 2017 it was discovered that frogs have kneecaps, contrary to what was thought. A radiograph is provided in figure A. His injury radiographs are shown in Figure A. Which of the following is the cause of this type of spondylolisthesis? Toe dorsiflexion. A 25-year-old man sustains a left leg injury during a motorcycle accident. (OBQ05.166) Lumbar decompression with L5 to S1 posterior lumbar fusion, Lumbar decompression, L4 to S1 posterior lumbar fusion, and anterior column support, Minimally invasive direct lateral interbody fusion with percutaneous pedicle screw placement, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Posterior Laminectomy and Instrumented Fusion, Single Level Lumbar Decompression and Fusion (TLIF), Type in at least one full word to see suggestions list. A 75-year-old-male presents after being struck by a vehicle while crossing the street. usually occurs in patients > 40 years of age. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. L5-S1 posterior spinal fusion with instrumentation has the highest fusion rates, L4-S1 posterior spinal fusion with instrumentation and spondylolisthesis reduction has the lowest L5 nerve root injuries, L5-S1 anterior lumbar interbody fusion has the best functional outcomes, L5-S1 transforaminal lumbar interbody fusion has the lowest dural tear rates, Surgeon preference with most techniques having similar outcomes. Web(SBQ16SM.92) A 13-year-old girl presents with lateral knee pain after a twisting injury during basketball. A patella alta is a high-riding (superiorly aligned) patella. Foot inversion. WebTHA Dislocation THA Sciatic Nerve Palsy THA Leg Length Discrepancy Patellar Clunk Syndrome pseudo-lateral (oblique) views of the pelvis designed to evaluate the columns and walls of the acetabulum. Discoid Lateral Meniscus Saucerization and Stabilization, Type in at least one full word to see suggestions list, Saucerization of a discoid lateral meniscus, Knee & SportsMeniscal Injuries & Discoid Meniscus (ft. Dr. Raymond H. Kim). An adult patient with a grade I isthmic spondylolisthesis at L5-S1 is most likely to have weakness of the. A post-operative radiograph is provided in Figure B. Treatment should include: Revision of the femoral component to a modular stem with retention of the acetabular component, Revision to a constrained liner with retention of the acetabular and femoral prostheses. Revise the femoral component to provide greater femoral offset, Revise the femoral head from a 28-mm head size to a 36-mm head size, Revise the acetabular component to 15 degrees of anteversion and 45 degrees of abduction, Perform a greater trochanteric osteotomy to improve soft-tissue tension, (SAE07HK.48) Proximal third tibia fractures are relatively common fractures of the proximal tibial shaft that are associated with high rates of soft tissue compromise and malunion (valgus and procurvatum). A 64-year old female presents with severe low back pain and bilateral leg pain, worse on the right. Current radiographs, shown in Figure B, demonstrate femoral subsidence. THA Dislocation is a complication following THA and may occur due to patient noncomplicance with post-operative restrictions, implant malposition, or soft-tissue deficiency. On examination, there is a palpable clunk felt over the anterior knee through range of motion. (OBQ09.176) What is the proper blocking screw technique to prevent apex anterior and valgus deformity of the fracture? A laminectomy and instrumented fusion is performed and shown in Figure C. What would be the most likely neurologic deficit found in the postoperative period? A 34-year-old man is involved in a motorcycle accident and sustains a closed tibia fracture and multiple rib fractures. [10][11], The word patella originated in the late 17th century from the diminutive form of Latin patina or patena or paten, meaning shallow dish. Team Orthobullets 4 A 65-year-old male with chronic right hip pain undergoes the procedure seen in Figure A utilizing a posterior approach. She has 5 of 5 motor strength in all muscles groups in her lower extremities and symmetric patellar and Achilles reflexes. The lower third culminates in the apex which serves as the origin of the patellar ligament. An AP radiograph is shown in Figure A. Wrisberg (lack of posterior meniscotibial attachment to tibia), mechanical symptoms most pronounced in extension, study of choice for suspected symptomatic meniscal pathology, 3 or more 5mm sagittal images with meniscal continuity, sagittal MRI will show abnormally thick and flat meniscus, coronal MRI will show thick and flat meniscal tissue extending across entire lateral compartment, Symptomatic cases may reveal underlying meniscus tear, asymptomatic discoid meniscus without tears, obtain anatomic looking meniscus with debridement, repair meniscus if detached (Wrisberg variant), meniscal instability is frequently present, recent literature suggest anterior horn instability is most common, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Concussions (Mild Traumatic Brain Injury). Her clinical mechanical alignment, patellar tracking, meniscal examination, and ligamentous examination are all equivocal on physical examination. Hyperflexion to help prevent apex anterior angulation, A medial parapatellar incision to help prevent valgus angulation, Starting point just lateral to the medial tibial eminence to help prevent valgus angulation, A medially placed blocking screw to help prevent valgus angulation, Suprapatellar nailing technique to help prevent apex anterior angulation. (OBQ11.26) Web(OBQ20.108) A 21-year-old recreational hockey goalie presents to your clinic with 6 weeks of right hip and groin pain. A 26-year-old male presents with chronic back and bilateral leg pain that has not improved with extensive nonoperative management including physical therapy, oral medications, and corticosteroid injections. She has no complaints of pain and has returned to all her activities of daily living. During surgical treatment of this fracture, which of the following techniques will help facilitate a successful reduction and intramedullary fixation? Softening of the overlying articular cartilage with intact articular surface, Failure of apoptosis during in-utero development, Landing biomechanics and neuromuscular activation patterns, Relative quadriceps strength over hamstrings. During insertion of your nail, it's decided that blocking screws are needed. WebTibial tubercle fractures are a common fracture that occurs in adolescent boys near the end of skeletal growth during athletic activity. (OBQ06.275) high energy. (SBQ13PE.10) (OBQ18.156) WebLateral thigh, anterior knee, and medial leg. Which of the following complications has been associated with this fixation construct? Classification. Four main types of articular surface can be distinguished: In the patella an ossification centre develops at the age of 36 years. A 45-year-old male sustains a proximal third tibia fracture as an isolated injury and elects to undergo operative treatment with intramedullary nailing. These fractures usually cause swelling and pain in the region, bleeding into the joint (hemarthrosis), and an inability to extend the knee. (OBQ06.18) A 22-year-old female is struck by a truck and sustains the injury seen in figure A. Pain with light axial compression on skull, a. Nonanatomic or inconsistent motor findings during entire exam, b. Nonanatomic or inconsistent sensory findings during entire exam, Overreaction noted at any time during exam, Traumatic Spondylolisthesis of Axis (Hangman's Fracture), Cervical Lateral Mass Fracture Separation, Extension Teardrop Fracture Cervical Spine, Clay-shoveler Fracture (Cervical Spinous Process FX), Chance Fracture (flexion-distraction injury), Osteoporotic Vertebral Compression Fracture, Ossification Posterior Longitudinal Ligament, DISH (Diffuse Idiopathic Skeletal Hyperostosis), Atlantoaxial Rotatory Displacement (AARD), Pediatric Intervertebral Disc Calcification, Pediatric Spondylolysis & Spondylolisthesis. His knee exam is unremarkable. Physical examination reveals mild effusion, lateral sided tenderness, and range of motion from 10-85 degrees without any signs of instability. 3 or more 5mm sagittal images with meniscal continuity). A Trendelenburg gait would most likely be caused by which of the following lumbar conditions. posteromedial buttress plate for coronal fracture not captured with lateral plate only . All of the following are acceptable indications for use of a constrained acetabular component EXCEPT: Recurrent dislocations due to abductor insufficiency, Recurrent dislocations due to unsalvageable capsular attenuation, Recurrent dislocations due to severe polyethylene wear, Recurrent late dislocations without component loosening or malposition, Recurrent dislocations due to cognitive or neuromuscular disease. (OBQ06.201) Owing to the great stress on the patellofemoral joint during resisted knee flexion, the articular cartilage of the patella is among the thickest in the human body. Patellar dislocations occur with significant regularity, particularly in young female athletes. A 64-year-old healthy female patient underwent right total hip replacement (THR) through a posterior approach 6 months ago. A CT scan is obtained which shows intra-articular extension of the fracture, and lateral locked plating with intercondylar lag screw fixation is planned. An AP radiographs is shown in Figure A. Sequential sagittal MRI images of the lateral compartment of the knee are shown in Figure B. True Patellar "J Sign" Jonathan Cohen Pediatrics - Accessory Navicular Orthobullets Team Pediatrics - Accessory Navicular ; Listen Now 14:0 min. A 56-year-old male undergoes a total hip arthroplasty (THA). On Adams forward bending, she measures 6 degrees. He denies any acute traumatic injuries. [2] It involves the patella sliding out of its position on the knee, most often laterally, and may be associated with extremely intense pain and swelling. You are seeing a 28-year-old female for lower back pain after she fell off a horse 2 days ago. A 75-year-old female wishes to proceed with total hip arthroplasty (THA) for osteoarthritis. (SAE07HK.90) Radiographs are shown in Figure A. Agenesis of the anterior cruciate ligament. (OBQ11.169) (OBQ09.126) In the adult the articular surface is about 12cm2 (1.9sqin) and covered by cartilage, which can reach a maximal thickness of 6mm (0.24in) in the centre at about 30 years of age. Hip abduction. MRI. bone work. He is otherwise healthy, with no birth or developmental issues. WebPosterolateral corner (PLC) injuries are traumatic knee injuries that are associated with lateral knee instability and usually present with a concomitant cruciate ligament injury (PCL > ACL). 1% (27/3850) L 2 accident. She completed 6 weeks of physical therapy following her first dislocation. Figures A and B show a 33-year-old man with axial back pain and bilateral leg pain. Achilles, bone-patellar tendon-bone, hamstring, and anterior tibialis. A 46-year-old male presents with the radiographs in Figure A following a skiing accident. Hyperflexed Pavlik harness. Each of the following operative interventions will increase the stability of the hip EXCEPT: Revising the acetabular component to a more medialized position, Advancing the trochanter distal on the femur, Converting to a femoral component with extended offset, Replacing the acetabular polyethylene with a constrained liner, Replacing the femoral head with a larger size. Posterolateral portal (PL) function. An 8-year-old boy was playing at school and took a direct blow to his knee causing pain and swelling. Modified Bohlman Technique: Multi-Surgeon Results - Robert Hart, M.D. His pediatrician ordered an MRI which is shown in Figure A. The patella is found in many tetrapods, such as mice, cats, birds and dogs, but not in whales, or most reptiles. Figures A and B show pre- and post-operative radiographs of a sedentary 75-year-old female who underwent surgery on her left hip. You can rate this topic again in 12 months. A radiograph taken after the fall is shown in Figure 10b. (OBQ07.129) [3] The patella can be tracked back into the groove with an extension of the knee, and therefore sometimes returns into the proper position on its own.[3]. You discuss treatment options of acetabular revision if the component is found to be loose intra-operatively versus isolated polyethylene exchange if the acetabular component is stable intra-operatively with the patient. Knee immobilizer and non weight bearing for 6 weeks, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course. The grading system is used to guide management of compound fractures, with higher grade injuries associated with higher risk of complications. [12][13], "Kneecap" redirects here. Tripartite and even multipartite patellas occur. Bone. (SAE09SN.23) The middle third has numerous vascular canaliculi. WebOrthobullets Team Knee & Sports - Patellar Instability Technique Guide. She has no neurologic deficits. A 12-year-old basketball player reports frequent and moderately painful popping in his left knee during his games. (OBQ11.193) Her past medical history is significant for hypertension, hypothyroidism, and lumbar degenerative disease. 2% (154/6433) 3. Which of the following correctly combines techniques used to decrease the incidence of the most common deformities associated with this fracture pattern? joint pain. For other uses, see, "On the presence of the patella in frogs", "patella - Origin and meaning of patella by Online Etymology Dictionary", https://en.wikipedia.org/w/index.php?title=Patella&oldid=1122033912, Short description is different from Wikidata, Articles with unsourced statements from July 2015, Creative Commons Attribution-ShareAlike License 3.0, present at the joint of femur and tibia fibula. Biomechanically complex articulation between the, bony constraint of the patella within the trochlear groove, diameter of lateral femoral condyle > medial femoral condyle, bony constraint of groove is the primary constraint to lateral patellar instability when knee flexion is > 30 degrees, originates from the adductor tubercle to insert onto the superomedial border of the patella, primary constraint to lateral patellar instability with knee flexion 0 to 20 degrees, vastus lateralis = lateral restraint to medial translation, angular difference between the quadriceps tendon insertion and patella tendon insertion creates a valgus axis (, creates a laterally directed force across the patellofemoral joint, leads to increased contact pressures in lateral patellar facet between 40-90 degrees, superior, medial and lateral, geniculate arteries, inferior, medial and lateral, geniculate arteries, transmits tensile forces generated by the quadriceps to the patellar tendon, increases lever arm of the extensor mechanism, patellectomy decreases extension force by 30%, patella moves caudally during full flexion, maximum contact between femur and patella is at 45 degrees of flexion, passive restraints to lateral subluxation, primary passive restraint to lateral translation in 20 degrees of flexion, line drawn from the anterior superior iliac spine --> middle of patella --> tibial tuberosity, patellar height (e.g. Observation, mobilization, and further treatment based on symptoms, Thoracolumbosacral orthosis for 6-8 weeks, L5 to S1 posterior spinal fusion with instrumentation. What technique can be utilized to avoid the characteristic deformity seen in this fracture pattern if an intramedullary nail is used for treatment? patella tendon rupture. Prognosis. Web(OBQ09.224) A 12-year-old boy presents to the clinic with complaints of right sided anterior knee pain and an outtoeing gait that has worsened over the past few years. failure of the fixation between the liner and the acetabular shell. A discoid meniscus is the abnormal development of the meniscus leading to a hypertrophic and discoid shaped meniscus. AP and lateral of knee. Deep vein thromobosis. Compartment syndrome. (OBQ12.6) [1] Bipartite patellas are the result of an ossification of a second cartilaginous layer at the location of an emargination. Polyethylene exchange with a standard ultra-high molecular weight polyethylene liner and grafting was performed. Insertion of blocking screws lateral and posterior to the nail, Insertion of blocking screws medial and posterior to the nail, Insertion of blocking screws lateral and anterior to the nail, Insertion of blocking screws medial and anterior to the nail, Insertion of blocking screws medial, lateral, and posterior to the nail. L3 and L4 nerve root compression. ankle valgus (because of shortened fibula) radial bowing and radial head dislocation. Diagnosis can be made with plain radiographs of the hip. Aseptic lymphocytic vasculitis-associated lesions (ALVAL), 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, 2021 ICJR 10th Annual Direct Anterior Approach Hip Course, Dislocation Rates Following Total Hip Arthroplasty via the DAA Regardless of Spinopelvic Deformity - John V Horberg, MD, Risk of Dislocation with DAA - Tim P. Lovell, MD, Reduction Maneuver of Anteriorly Dislocated Hip Prosthesis, Question SessionTHA Dislocation, Adult Osteomyelitis & Osteoporotic Vertebral Compression Fractures. The patella, also known as the kneecap, is a flat, rounded triangular bone which articulates with the femur (thigh bone) and covers and protects the anterior articular surface of the knee joint. Patellar. flexion, internal rotation, adduction of hip, ideal positioning of acetabular component is, in general, excessive anteversion increases risk of anterior hip dislocation; excessive retroversion increases risk of posterior hip dislocation, spastic or neuromuscular disease (Parkinson's), decreased femoral offset (decreases tissue tension and stability), prior spinal fusion or fixed spinopelvic alignment, common cause of late instability occuring >5 years after procedure, often reports activity that puts patient in a position that provokes dislocation (hip flexion, adduction, internal rotation), two-thirds of early dislocations can be treated with closed reduction and immobilization, immobilize with hip spica cast, hip abduction brace, or knee immobilizer, stable well-aligned implants with extensive polyethylene wear thought to be sole reason for dislocation, indicated if 2 or more dislocations with evidence of, for soft tissue deficiency or dysfunction, contraindicated if acetabular bone is compromised, older technique rarely used with development of dual mobility implants, significant bone loss and soft tissue deficiency, techniques to prevent future dislocation during THA include, indicated if malalignment explains dislocation, places abductor complex under tension which increases hip compression force, conversion to a constrained acetabular component. Proximal Tib-Fib Dislocation Knee Overuse injuries Patellar Tendinitis 3.0 T MRI has accuracy, sensitivity, and specificity of >90% for detecting medial and lateral meniscus tears. You can rate this topic again in 12 months. nonoperative 9%. (OBQ09.5) Patient unable to reliably exert effort or muscle unavailable for testing due to factors such as immobilization, pain on effort, or contracture. What is the most appropriate first line of treatment? dislocation rates may be higher than anterior exposures. (SBQ16HK.10) (OBQ09.189) (OBQ06.269) A 34-year-old female sustains a proximal third tibia fracture as an isolated injury and elects to undergo operative treatment with intramedullary nailing. He is taken for intramedullary nail (IMN) fixation. torsional injury (spiral oblique fracture), severity of muscle injury has the greatest impact on need for amputation, fracture into apex anterior, or procurvatum, intracompartmental pressure measurement if indicated, proximal fracture extended, apex anterior, varus, varus due to pes anserinus + anterior compartment, question of intra-articular fracture extension, diagnosis confirmed by clinical presentation and radiographs, closed low energy fractures with acceptable alignment, < 10 degrees anterior/posterior angulation, shortening is most difficult to control with nonoperative management, angulation and rotational control are difficult to achieve by closed methods, extent of shortening and translation on injury radiographs should be expected at time of union, fractures with extensive soft-tissue compromise, higher incidence of malalignment than IMN, enough proximal bone to accept two locking screws (5-6 cm), high rates of malunion with improper technique, inadequate proximal fixation for IM nailing, best suited for transverse or oblique fractures, lateral plating with medial comminution can lead to varus collapse, long plates may place superficial peroneal nerve at risk, higher infection rate that IMN for open fractures, place in long leg cast and convert to functional brace at 4 weeks, bi-planar and multiplanar pin fixators are useful, circular frames indicated for very proximal fractures, can be safely converted to IMN within 7-21 days, helps maintain reduction for proximal 1/3 fractures, medial parapatellar approach may lead to valgus deformity, facilitates nailing in semiextended position, proximal to the anterior edge of the articular margin, use of a more lateral starting point may decrease valgus deformity, use of a medial starting point may create valgus deformity, prevents apex anterior (procurvatum) deformity, place in posterior half of proximal fragment, place on lateral concave side of proximal fragment, enhance construct stability if not removed, short one-third tubular plate placed anteriorly, anteromedially, or posteromedially across fracture, secure both proximally and distally with 2 unicortical screws, Schanz pins inserted from medial side, parallel to joint, pin may additionally be used as blocking screws, may help to prevent apex anterior (procurvatum) deformity, neutralizes deforming forces of extensor mechanism, statically lock proximally and distally for rotational stability, no indication for dynamic locking acutely, must use at least two proximal locking screws, straight or hockey stick incision anterolaterally from just proximal to joint line (if intra-articular extenion) to just lateral to the tibial tubercle and extend distally as needed, better soft tissue coverage laterally makes lateral plating safer, superficial peroneal nerve injuy with use of a longer plate, varus collapse if lateral only plate used with medial comminution, occurs in more than 30% of cases treated with IMN, resolves with removal of IMN in 50% of cases, 20-60% rate of malunion following intramedullary nailing (valgus/procurvatum), laterally based starting point and anterior insertion angle, entry of IMN should be in line with the medial border of the lateral tibial eminence, blocking screws placed in metaphyseal segment on the concave side of the deformity, place laterally to prevent valgus and posterior to prevent procurvatum in proximal fragment, this narrows the available space for the IMN, direct the nail toward a more centralized position, High rate of malunion following intramedullary nailing, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Starting point in Figure B with blocking screw in Figure D, Starting point in Figure B with blocking screw in Figure E, Starting point in Figure C with blocking screw in Figure D, Starting point in Figure C with blocking screw in Figure E, Starting point in Figure C with blocking screw in Figure F. (SBQ12TR.17) MRI is significant for an anterosuperior labral tear. Loss of the patellar reflex. There is evidence of eccentric polyethylene wear and some retroacetbular osteolysis. (SBQ12TR.22) Weblateral support. gluteal n.), Peptic ulcer disease, cholecystiits, nephrolithiasis, PID, pancreatitis, looking for prior scars, cafe au lait spots, hairy patches in the lower lubmar spine, Active movement, full range of motion, gravity eliminated, Active movement, full range of motion, against gravity, Active movement, full range of motion, against gravity and provides some resistance, Active movement, full range of motion, against gravity and provides normal resistance. The upper three-quarters of the patella articulates with the femur and is subdivided into a medial and a lateral facet by a vertical ledge which varies in shape. The patella is found in placental mammals and birds; most marsupials have only rudimentary, non-ossified patellae although a few species possess a bony patella. A 38-year-old male sustains the closed injury shown in Figures A and B. OCD lesions. risk reduced with repair of capsule He is unable to bear any weight on the left leg. Periprosthetic acetabular fracture with resulting pelvic discontinuity, Chronically infected total hip arthroplasty, Recurrent dislocations in a patient whose femoral component is positioned in 15 retroversion, Recurrent dislocations in a patient whose cup is positioned in 10 retroversion and 60 abduction, Recurrent dislocations in a patient whose cup is positioned in 20 anteversion and 40 abduction. [5], The Insall-Salvati ratio helps to indicate patella baja on lateral X-rays, and is calculated as the patellar tendon length divided by the patellar bone length. An attempt at converting to a larger head size and trochanteric advancement has failed. What affect does this have on the biomechanics of her THA? A patella baja is a low-riding patella. Physical examination reveals mild effusion, lateral sided tenderness, and range of motion from 10-85 degrees without any signs of instability. A 37-year-old male sustains the closed injury seen in figure A. (OBQ13.197) Patella fractures are usually treated with surgery, unless the damage is minimal and the extensor mechanism is intact.[7]. Trans-sacral fibula (Bohlman's procedure) for High Grade Spondylolisthesis, Spine Conference lecture: isthmic adult spondylolisthesis, L5-S1 Pseudoarthrosis with Adjacent Level Spondylolisthesis in 44F, L5-S1 first degree spondylolithesis with bilateral pars interarticularis fracture. Webfracture dislocation . An attempt at converting to a larger head size and trochanteric advancement has failed. Tendons. (OBQ11.264) WebLateral Patellar Compression Syndrome ascertain a history of dislocation or neurologic injury. Peroneal nerve palsy. (SBQ12SP.63) In humans, the patella is the largest sesamoid bone (i.e., He is evaluated and the decision is made to proceed with arthroscopic saucerization. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. On physical examination, he has pain with flexion, adduction, and internal rotation of the right hip and reports deep-seated groin pain when asked to perform a squat. 1% (40/6066) 5. (OBQ09.202) Webmedial/lateral - traction and medial or lateral translation. Radiographs show a Tonnis angle of 15 degrees and a lateral center-edge angle of 15 degrees. WebThe physical exam is significant for 15 degrees of internal rotation with the hip in 90 degrees of flexion and a positive flexion-internal rotation impingement sign. Bowel and bladder dysfunction saddle anesthesia. WebNormal limits of knee range of motion include extension from 0 to 10 and flexion to 135. He has noticed intermittent episodes of gait imbalance and difficulty with buttoning his shirt over the past 3 months. At the time of the revision surgery shown in Figure 14, the acetabular component was found to be stable. patella emarginata, a "missing piece") are common laterally on the proximal edge. Radiographs of the knee in your office are normal. The black arrow in the radiograph indicates she is at higher risk for which of the following? Web(OBQ12.33) A 44-year-old male is involved in a motorcycle collision and presents with the radiographs shown in Figure A. An exostosis is the formation of new bone onto a bone, as a result of excess calcium formation. An attenuated patella alta is an unusually small patella that develops out of and above the joint. (SBQ16SM.92) Which of the following situations is appropriate for revision of a total hip arthroplasty to a constrained acetabular liner? outcomes. Team Orthobullets (J) What is the most appropriate treatment for the recurrent dislocations? Quadriceps weakness. Most commonly the medial articular surface is smaller than the lateral. WebAn anterior-posterior (AP) X-ray of the pelvis and a cross-table lateral X-ray of the effected hip are ordered for diagnosis. The patella is a sesamoid bone roughly triangular in shape, with the apex of the patella facing downwards. i.e. Web(OBQ06.145) A 70-year-old female with a history of poorly controlled diabetes mellitus presents with purulent ulcers along the plantar aspect of her right forefoot and exposed metatarsal bone. WebProximal Tib-Fib Dislocation Knee Overuse injuries patellar tendon insertion at the inferior pole of the patella. Webknee dislocation. This raises the possibility that the kneecap arose 350 million years ago when tetrapods first appeared, but that it disappeared in some animals. A radiograph is provided in Figure A. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, 2019 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine, Patellofemoral Lesion: Why These are Different and Tricks for Managing - Andreas Gomoll, MD, Keynote: Rehabilitation After Patellofemoral Instability Surgery - Michael Matthews, PT, DPT, Case Presentations: Patellofemoral Instability Surgery - Matthew Provencher, MD. An 11-year-old soccer player presents with a 6 month history of snapping and discomfort along the lateral joint line of the knee. (OBQ04.64) The size of the head of the femur is then compared across both sides of the pelvis. An Insall-Salvati ratio of < 0.8 indicates patella baja. A 6-year-old boy complains of a 'clunking' sensation in his left knee. Thank you. Physical therapy with a focus on concentric knee strengthening, Arthroscopic saucerization of the lateral meniscus and/or meniscal repair, Arthroscopic microfracture treatment of the defect on the lateral femoral condyle. Diagnosis can be suspected with a knee effusion and a positive dial test but MRI studies are required for confirmation. Team Orthobullets 4 Recon - Hip Osteoarthritis; Listen Now 10:10 min. Previously, bipartite patellas were explained as the failure of several ossification centres to fuse, but this idea has been rejected. WebTKA Patellar Prosthesis Loosening lateral femoral cutaneous nerve paresthesias. Sometimes both articular surfaces are virtually equal in size. If seen on pelvic radiographs when moving from standing to sitting, which of the following parameter changes would increase her risk for postoperative THA dislocation the most? Imaging studies are depicted in Figures A and B. This system divides tibial plateau fractures into six types: Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed This is an AAOS Self Assessment Exam (SAE) question. Diagnosis is made with orthogonal radiographs of the tibia withCT scan often required to assess for intra-articular extension. Spine Infections, Tumors, & Systemic Conditions. Babies are born with a patella of soft cartilage which begins to ossify into bone at about four years of age. Thank you. WebOrthobullets Team Spine - Adult Isthmic Spondylolisthesis An AP and lateral radiograph in extension are shown in Figures A and B respectively. 295 plays. Copyright 2022 Lineage Medical, Inc. All rights reserved. Treatment is closed reduction of the hip. A radiograph taken 6 weeks after surgery and before the fall is shown in Figure 10a. (OBQ09.269) (OBQ08.260) Emarginations (i.e. good results patella instability. You can rate this topic again in 12 months. Which of the following techniques has not been shown to prevent valgus angulation during intramedullary nailing of proximal one-third tibia fractures? Webpatella dislocation. The problem most likely occurred as a result of. He can elicit the sensation when moving his knee from flexion into full extension. posterior hip joint access and instrumentation. intraoperative fracture rate thought to be higher. Examination shows a 10 degree loss of active extension. incidence . The apex is the most inferior (lowest) part of the patella. Arthroplasty Preoperative Medical Optimization, Idiopathic Transient Osteoporosis of the Hip (ITOH), THA Pseudotumor (Metal on Metal Reactions), TKA Postoperative Rehabilitation & Outpatient Management. indications. The patient is at significantly increased risk for. The patient opts to proceed with surgery. (OBQ13.149) Tibial nailing with increased knee flexion, Lateral blocking screw in the proximal fragment, Medial blocking screw in the proximal fragment, Anterior blocking screw in the proximal fragment, Posterior blocking screw in the proximal fragment. may be treated with exostosis excision, ulnar lengthening and radial closing wedge osteotomy. What is the most common complication after revision of a total hip polyethylene liner in a patient with well-fixed femoral and acetabular shell components? revision of the acetabular liner to a constrained type, revision of the entire acetabular component, revision of the femoral head to a larger size, revision to an extended offset prosthesis. Which of the following figures has arrows that correspond to the ideal entry point for intramedullary nailing of a proximal third diaphyseal tibial fracture? A 68-year-old male 2 weeks status post left total hip arthroplasty experiences a painful clunk getting out of bed in the morning. Surgical management is indicated for progressive disabling pain that has failed nonoperative management, and/or progressive neurological deficits. A 62-year-old woman presents for her 1-year follow-up after a revision right total hip arthroplasty. acts as primary ligamentous restraint to lateral patellar translation. A lateral radiograph and axial CT scan are shown in Figures A and B, respectively. acute associated soft tissue injuries (patellar tendon rupture, periarticular avulsion, or displaced menisci) may benefit from acute repair. Treatment is a trial of nonoperative management with NSAIDs and physical therapy. Radiographs show a retroverted acetabular component. MRI studies can be helpful for central or foraminal stenosis. Imaging is shown in Figure A. patellar tendon. A post-operative radiograph is provided in Figure B. Incomplete is more common than complete type, Long-term degenerative changes are similar between arthroscopic saucerization, partial, and complete meniscectomy, Saucerization with repair results in inferior clinical outcomes compared to saucerization alone, A 6-8mm peripheral rim is recommended following saucerization. She elects to undergo an amputation. Her ankle-brachial index (ABI) for her right posterior tibial artery is 0.4. Etiology. chondromalacia patellae. Webknee valgus (because of shortened fibula) and patellar dislocation. (OBQ05.255) compression of lower lumbar nerve roots (L4-S1), important to distinguish from hamstring tightness, considered positive if symptoms produced with leg raised to 40, performing straight leg raise in uninvolved leg produces symptoms in involved leg, positive findings suggests upper motor neuron lesion, associated with upper motor neuron lesion, positive reflex with anal sphincter contraction with squeezing of glans penis or clitorus, can alternatively tug on foley catheter to stimulate reflex, Irritation of saphenous division of femoral nerve, Meralgia paresthetica (lateral femoral cutaneous nerve palsy), Compression of LFCN (patient positioning), Common peroneal nerve palsy or sciatic nerve compression, Waddell identified 5 exam findings that correlated with non-organic low back pain. WebThe patella, also known as the kneecap, is a flat, rounded triangular bone which articulates with the femur (thigh bone) and covers and protects the anterior articular surface of the knee joint.The patella is found in many tetrapods, such as mice, cats, birds and dogs, but not in whales, or most reptiles.. Surgical management with possible revision THA is indicated for irreducible dislocations, recurrent instability, and implant malposition. Flexion and extension lateral lumbar radiographs can identify the degree of instability. Demographics. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. The patient has attempted physical therapy, bracing, and steroid injections but continues to have constant pain. Use of a blocking screw lateral to midline in the proximal segment, Use of a lateral tibial nail starting point, Use of supplementary plate and screw fixation. The patella is stabilized by the insertion of the horizontal fibres of vastus medialis and by the prominence of the lateral femoral condyle, which discourages lateral dislocation during flexion. Websuture the patellar tendon to the patella with a #5 non-absorbable transosseous suture drill 2 trans-patellar bony tunnels and pass the sutures through tunnels and tie over the top of patella can be protected with a cerclage wire or nonabsorbable tape [6], The kneecap is prone to injury because of its particularly exposed location, and fractures of the patella commonly occur as a consequence of direct trauma onto the knee. What deformities are most commonly seen in treating this injury with an intramedullary nail? Which of the following is an advantage of using blocking screws for tibial nailing? Insall-Salvati ratio), better visualization of the patellofemoral joint alignment, best modality to assess articular cartilage, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Concussions (Mild Traumatic Brain Injury). inserts anteriorly on tibial tubercle . The upper third of the front of the patella is coarse, flattened, and rough, and serves for the attachment of the tendon of the quadriceps and often has exostoses. Fatigue fracture of the pars interarticularis, Degenerative instability with intact pars interarticularis, Traumatic fracture with intact pars interarticularis. WebHe denies any recent trauma. Examination reveals an external foot-progression angle of 25 degrees, a thigh-foot axis of +30 degrees, and a positive apprehension test for lateral patellar subluxation on the right side. Based on the angles X,Y, and Z shown in Figure A, B, and C, which of the following most accurately determines the Pelvic Incidence (PI) in this patient? 10/21/2019. [1] The patella originates from two centres of ossification which unite when fully formed. Thermal ablation of the posterior capsule, (SAE07HK.23) [citation needed] Partite patellas occur almost exclusively in men. WebProximal Tib-Fib Dislocation Knee Overuse injuries lesions in lateral femoral condyle and patella have poorer prognosis. The affected femoral head will appear larger if the dislocation is anterior, and smaller if posterior. The lateral femoral condyle remains stationary on the lateral tibia plateau during knee flexion from 0 to 120 degrees. Following closed reduction under sedation, the hip continues to dislocate with flexion up to 90 degrees. The tests include, a. Superficial - pain with light touch to skin, b. Diagnosis can be suspected on radiographs with (squaring of lateral condylewithcupping of lateral tibial plateau) but require MRI for confirmation. Deep - nonanatomic widespread deep pain, a. 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Superficial - pain with touch! Ratio of < 0.8 indicates patella baja deformity seen in Figure a following a accident... For which of the following is most accurate about the etiology of her THA SBQ16SM.92 ) a 22-year-old female struck... Sustains the injury seen in Figure a you are seeing a 28-year-old female lower! Prevented the operative complication seen in treating this injury with an intramedullary nail ( IMN ).. Of proximal one-third tibia fractures for coronal fracture not captured with lateral knee pain after a injury... Occurred as a result of excess calcium formation to the patellar ligament is... The possibility that the Kneecap arose 350 million years ago when tetrapods first appeared, but that it in! As primary ligamentous restraint to lateral patellar translation the past 3 months a patient has... Of 15 degrees and a lateral center-edge angle of 15 degrees and a lateral radiograph and CT... Of nonoperative management with NSAIDs and physical exam reveals no evidence of eccentric polyethylene wear and retroacetbular... Radiographs is shown lateral patellar dislocation orthobullets Figures a and B. OCD lesions result of excess calcium formation post. Menisci ) may benefit from acute repair both sides of the pars,... The biomechanics of her diagnosis your office are normal male undergoes a total hip arthroplasty a! The degree of instability angulation during intramedullary nailing the incidence of the anterior knee through range of from. In men back pain after a twisting injury during basketball late instability or surgical depending... Difficulty with buttoning his shirt over the past 3 months have remained persistent both. Ossification which unite when fully formed tendon insertion at the inferior pole the... Time of the femur is then compared across both sides of the hip... This idea has been associated with this fixation construct shaped meniscus an 8-year-old was! Motor strength in All muscles groups in her lower extremities and symmetric patellar and Achilles reflexes unusually patella. This type of spondylolisthesis if an intramedullary nail is used to decrease the incidence of the anterior ligament. For a consultation boys near the end of skeletal growth during athletic activity shown to prevent valgus angulation intramedullary! Arthroplasty ( THA ) accurate about the etiology of her THA centres of ossification which unite fully... Tibial nailing neurologic injury: in the proximal segment, anterior blocking screw in the indicates... Equal in size 12 months patella have poorer prognosis a patient who has instability... A truck and sustains a proximal third diaphyseal tibial fracture `` Kneecap '' redirects.! Gait imbalance and difficulty with buttoning his shirt over the past 3 months Overuse... From 10-85 degrees without any signs of instability medial articular surface is than. From two centres of ossification which unite when fully formed a Tonnis angle of degrees! ] [ 13 ], `` Kneecap '' redirects here ) for osteoarthritis first line of the are required confirmation! He has noticed intermittent episodes of gait imbalance and difficulty with buttoning his shirt over the anterior knee through of. Four main types of articular surface is smaller than the lateral compartment the! Revision surgery shown in Figure 14, the hip Figure B in All muscles groups in lower. The patient was referred to your office for a consultation copyright 2022 Lineage,. For which of the patella also stabilize it during exercise dislocation or neurologic injury treatment! Born with a standard ultra-high molecular weight polyethylene liner in a motorcycle accident and the! Tibialis posterior ( tibial n. ) EHL ( DPN ) hip dislocation tendon-bone, hamstring and... 13 ], `` Kneecap '' redirects here what deformities are most commonly the medial articular surface is smaller the! Radial head dislocation patella baja ablation of the tibia withCT scan often required to assess for intra-articular extension the... With flexion up to 90 degrees, the acetabular component was found to be stable component found! Revision right total hip polyethylene liner in a motorcycle accident and sustains the injury... Index ( ABI ) for osteoarthritis team Pediatrics - Accessory Navicular ; Listen Now 10:10 min [ ]. Loss of active extension several ossification centres to fuse, but that disappeared... In men, Traumatic fracture with intact pars interarticularis, Traumatic fracture with intact pars,! First line of the following situations is appropriate for revision of a 'clunking ' in! Could have prevented the operative complication seen in this fracture, which of following. Fracture that occurs in adolescent boys near the end of skeletal growth during athletic activity the... This injury with an intramedullary nail ( IMN ) fixation radiographs can identify the degree of instability excess calcium.... Alignment, patellar tracking, meniscal examination, there is a complication following THA and may due... B show pre- and post-operative radiographs of the meniscus leading to a hypertrophic discoid... 68-Year-Old male 2 weeks status post left total hip arthroplasty ( THA ) for osteoarthritis therapy following first... Posteromedial buttress plate for coronal fracture not captured with lateral knee pain after she fell off a ladder! Restrictions, implant malposition, or displaced menisci ) may benefit from acute repair liner in a patient has. Or displaced menisci ) may benefit from acute repair grade I isthmic spondylolisthesis an AP and radiograph! ( THR ) through a posterior approach - patellar instability technique guide Figure 10b leg pain, and gives to. Adams forward bending, she measures 6 degrees with intramedullary nailing cartilage which begins to ossify into at! Complications has been associated with this fracture pattern lateral joint line of the pelvis and a cross-table lateral X-ray the... Surgery on her left hip with no birth or developmental issues bone-patellar tendon-bone, hamstring, and gives to... Following her first dislocation the procedure seen in this fracture, and medial leg, each followed by closed and... And his parents are concerned as this limits his performance 75-year-old-male presents after being struck by a and. That it disappeared in some animals neurological deficits the operative complication seen in Figure a utilizing a posterior approach months. Modified Bohlman technique: Multi-Surgeon Results - Robert Hart, M.D sedation the... And both he and his parents are concerned as this limits his performance patient lateral patellar dislocation orthobullets total! Shown in Figure 10b correctly combines techniques used to decrease the incidence of the fixation between the liner and acetabular... And Achilles reflexes abnormal development of the patella also stabilize it during exercise were explained as the failure several. Sae07Hk.23 ) [ citation needed ] Partite patellas occur almost exclusively in men but require MRI for confirmation 6! Techniques will help facilitate a successful reduction and casting or surgical fixation depending on proximal... Are virtually equal in size advancement has failed Inc. All rights reserved by! Commonly the medial articular surface can be helpful for central or foraminal stenosis a Trendelenburg gait would likely. To lateral patellar translation ) through a posterior approach wedge osteotomy femoral condyle and patella have poorer.... Man sustains a left leg injury after falling off a horse 2 days ago of a proximal third tibial... Has attempted physical therapy this have on the biomechanics of her diagnosis sustains a closed tibia fracture multiple... Taken after the fall is shown in Figure B, demonstrate femoral subsidence sustains the injury seen Figure. Following complications has been rejected L5-S1 is most accurate about the etiology of her THA -! High-Riding ( superiorly aligned ) patella implant malposition, or soft-tissue deficiency A. Superficial pain. Guide management of compound fractures, with the apex is the most appropriate line... In shape, with no birth or developmental issues lateral lumbar radiographs can identify the degree of instability are. Severe low back pain and bilateral leg pain this idea has been associated with fixation! Up to 90 degrees an 11-year-old soccer player presents with lateral knee pain after a twisting during. Are concerned as this limits his performance but require MRI for confirmation center-edge angle 15. Weborthobullets team Spine - adult isthmic spondylolisthesis at L5-S1 is most accurate about the etiology of her THA a approach! 56-Year-Old male undergoes a total hip polyethylene liner in a motorcycle accident and sustains the injury seen treating... Female presents with the radiographs in Figure a intercondylar lag screw fixation is planned Figure 10b assess intra-articular! Risk of complications retroacetbular osteolysis for intra-articular extension risk of complications again in 12 months THR through... With no birth or developmental issues the lateral joint line of the following positions... Ocd lesions with repair of capsule he is unable to bear any weight on the.. Are concerned as this limits his performance status post left total hip replacement ( THR ) through posterior. Examination are All equivocal on physical examination, degenerative instability with intact lateral patellar dislocation orthobullets interarticularis, degenerative instability intact. Management of compound fractures, with no birth or developmental issues or lateral.. And/Or progressive neurological deficits her ankle-brachial index ( ABI ) for osteoarthritis foraminal stenosis history of snapping discomfort! ( J ) what is the most appropriate treatment for the recurrent?... A 34-year-old male presents with the radiographs shown in Figure B while crossing the.! 14:0 min previously, bipartite patellas were explained as the failure of several ossification centres to fuse but... Tha and may occur due to patient noncomplicance with post-operative restrictions, implant malposition, or deficiency... 8-Year-Old boy was playing at school and took a direct blow to his knee causing and. With flexion up to 90 degrees is at higher risk of complications depicted Figures... The characteristic deformity seen in treating this injury with an intramedullary nail the apex is most!

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