metatarsal stress fracture orthobullets

5th Metatarsal Base Fracture Metatarsal FX Tarsal Navicular FX external rotation stress test. Lumbar radiculopathy. 5th Metatarsal Base Fracture gravity stress view can identify medial clear space widening. Time to definitive surgical procedure has no effect on outcome, Open reduction with capsular decompression is contraindicated, Internal fixation with a cephalomedullary nail leads to higher union rates than screw fixation, Nonunion is the most common complication if surgical intervention is performed, Closed reduction and cannulated screw fixation across the physis is an acceptable form of surgical management. Studies. Nonoperative. Nonoperative. (OBQ13.151) (SBQ12FA.39) 75-year-old woman with long standing rheumatoid arthritis presents with worsening bilateral foot pain. normal deltoid ligament. Copyright 2022 Lineage Medical, Inc. All rights reserved. Stop 1-2 days before for major procedures. Freiberg's Disease is a rare foot condition characterized by infarction and fracture of the metatarsal head. 75-year-old woman with long standing rheumatoid arthritis presents with worsening bilateral foot pain. The perioperative use of which medication has been shown to increase the risk of post-operative infection following orthopaedic procedures in patients with rheumatoid arthritis (RA)? Only when nonoperative treatment fails is surgical reconstruction indicated. (OBQ06.144) 2% (29/1804) 4. Bite The Bullet, He Needs Long Term Function: Be The Hated Person - Robert Anderson, MD. trauma leading to forced external rotation and abduction of ankle. She has failed conservative treatment and radiographs are shown in Figure A. rest, NSAIDS, taping, stiff-sole shoe or walking boot Metatarsal head fracture. Stop 1 week prior to procedure. grade 1: clean wound <1 cm in length; grade 2: wound 1-10 cm in length without extensive soft-tissue damage, flaps or avulsions; grade 3: extensive soft-tissue laceration (>10 cm) or tissue loss/damage or an open segmental fracture 5.0 (1) See More See Less. Diagnosis is suspected with hallux pain that is worse with hyperextension and can be confirmed with MRI studies. Which of the following drugs is an IL-1 antagonist typically used as a second line agent in the treatment of rheumatoid arthritis? Operative. 5th metatarsal base fractures are common traumatic fractures among athletic populations that are notorious for nonunion due to tenuous blood supply. Tenosynovectomies with extensor indicis proprius (EIP) to EDQ transfer, Tenosynovectomies with extensor reconstructions (central slip imbrication, Fowler distal tenotomy), Metacarpal joint resection arthroplasties with palmaris autograft interposition, Extensor tendon relocation, extrinsic tendon release, and metacarpophalangeal joint collateral ligament reefing. Acute medial sesamoid fracture. A representative coronal MRI sequence at the level of the cuboid is shown in Figure A. Intra-operatively, the peroneal tendon located directly posterior to the fibula is found to be normal. Which of the following surgical options would most reliably return her to sporting activities in a timely fashion? tarsal fracture. Thank you. Stress fracture. thought to be related to a disruption in the blood supply due to microtrauma or osteonecrosis and stress overloading. Stage 1. 93 plays. The patient has palpable pulses, active drainage at the ulcer, and does not have protective sensation with a 5.07 Semmes-Weinstein filament. A representative coronal MRI sequence at the level of the cuboid is shown in Figure A. Intra-operatively, the peroneal tendon located directly posterior to the fibula is found to be normal. Calcaneal Lengthening Osteotomy Fifth metatarsal fracture. most common extra-articular manifestation of RA, seen in 25% of patients with RA and associated with, erosion through skin may lead to formation of sinus tract, patients complain of pain and cosmetic concerns, cosmetic concerns, pain relief, diagnostic biopsy, seen in patients with RA or psoriatic arthritis, digits develop gross instability with bone loss (, treated with interposition bone grafting and fusion, volar subluxation associated with ulnar drifting of digits, extrinsic extensor tendons subluxate ulnarly, lax collateral ligaments allow ulnar deviation deformity, ulnar intrinsics contract further worsening the deformity, thumb MCP involvement + thumb IP involvment, important to correct wrist deformity at same time if it is radially deviated, synovectomy, volar capsular resection, ulnar collateral ligament release, radial collateral ligament repair/reconstruction, extensor tendon realignment, intrinsic tendon release, 1 year followup shows improved ulnar drift and extensor lag, thumb MCP involvement without IP involvement, FDS, volar plate and collateral ligament attenuation, contracture of triangular ligament, attenuation of, for flexible PIP (prevent hyperextension), Nalebuff Classification of Rheumatoid Thumb Deformities, Stage 1: Synovectomy with extensor hood reconstruction, Stage 3: IP and MCP fusion (if CMC is normal). 5th Metatarsal Base Fracture gravity stress view can identify medial clear space widening. Percutaneous pinning of the physeal fracture and long leg cast placement. Galeazzi Fracture - Pediatric stress fractures along the fourth and/or fifth metatarsal bases can develop secondary to repetitive load along the lateral border of the foot. A 72-year-old female with rheumatoid arthritis is scheduled to undergo total hip arthroplasty. She sees a podiatrist for shaving of her plantar forefoot calluses. 12% (235/2011) 3. Which of the following is more likely to occur following a total knee arthroplasty without patellar resurfacing versus a total knee arthroplasty with patellar resurfacing in patients with rheumatoid arthritis? Cotton. leads to eventual collapse of 2nd MT head. Calcaneonavicular Ligament (Spring Ligament) Function. Acute medial sesamoid fracture. 12% (235/2011) 3. 2% (68/3108) 5. Smillie Classification. Which of the following medications when combined with methotrexate has been shown to be more effective than methotrexate alone in the treatment of rheumatoid arthritis? Only when nonoperative treatment fails is surgical reconstruction indicated. Galeazzi Fracture - Pediatric stress fractures along the fourth and/or fifth metatarsal bases can develop secondary to repetitive load along the lateral border of the foot. Ankle sprains involve an injury to the ATFL and CFL and are the most common reason for missed athletic participation. most common form of inflammatory arthritis, an IgM antibody against native IgG antibodies, immune complex is then deposited in end tissues like the kidney as part of the pathophysiology, are the primary cellular mediator of tissue destruction in RA, are part of cascade that leads to joint damage, antigen-antibody and antibody-antibody reactions, microvascular proliferation and obstruction, synovial pannus formation (histology shows, joint subluxation, chondrocyte death/joint destruction, and deformity, associated with specific HLA loci (HLA-DR4 & HLA DW4), ~15% rate of concordance amongst monozygotic twins, Felty's syndrome (RA with splenomegaly and leukopenia), Still's disease (acute onset RA with fever, rash and splenomegaly), Sjogren's syndrome (autoimmune condition affecting exocrine glands), Decreased secretions from salivary and tear duct glands, may also affect knees, cervical spine, elbows, ankle and shoulder, ulnar deviation with metacarpophalangeal (MCP) subluxation, swan neck deformity, hallux valgus, claw toes, metatarsophlanageal (MTP) subluxation, joints become affected at later stage in disease process, medial migration of femoral head past the radiographic teardrop, also seen in Marfan's syndrome, Paget's disease, Otto's pelvis and other metabolic bone conditions, (cyclic citrullinated peptide, most sensitive and specific test), anti-MCV (mutated citrullinated vimentin), Diagnostic Criteria (1987 Revised Criteria for Diagnosis of RA), Radiographic changes of the hand including bony erosions and decalcification, Arthritis of the hand (MCP, PIP) and wrist, have 4 of 7 criteria for a 6 week period, first line includes NSAIDS, antimalarials, remittent drugs (gold, sulfasalazine, methotrexate), steroids, cytotoxic drugs, more aggressive approach with DMARDs is now favored over pyramid approach, significant advances in pharmacologic management have significantly changed prognosis of disease, operative treatment dictated by specific condition, significant advances in pharmocologic management have led to a decrease in surgical intervention, important to obtain preoperative cervical spine radiographs, Disease modifying anti-rheumatic drugs (DMARDs), A folate analogue with anti-inflammatory properties linked to inhibition of neovascularization therapeutic, effects increased when combined with tetracyclines, Exact mechanism unknown, but associated with a decrease in ESR and CRP, Blocks the activation of toll-like receptors (TLR), which decreases the activity of dendritic cells, thus mitigating the inflammatory process, TNF-alpha receptor fusion protein (TNF type II receptor fused to IgG1: Fc portion) that binds to TNF-alpha, Human mouse chimeric anti-TNF-alpha monoclonal antibody, Pegylated human anti-TNF-alpha monoclonal antibody, DMARDS / Biologic Agents /IL-1 antagonists, Monoclonal antibody to CD20 antigen (inhibits B cells), Selective co-stimulation modulator that binds to CD80 and CD86 (inhibits T cells), Monoclonal antibody targeting IL-12 and IL-23, IL6 receptor inhibitor (2nd line treatment for poor response to TNF-antagonist therapy), Stop 5 half lives before surgery (stop ASA 7-10 days before), Dosing depends on level of potential surgical stress, Continue for minor procedures. tarsal fracture. 5th Metatarsal Base Fracture Metatarsal FX Navicular stress fracture. Treatment is primarily medical management with NSAIDS, DMARDS, biologics, antimalarials, and steroids. Her radiographs and bone scan are shown in Figures A and B. can result in 5th metatarsal stress fractures. Treatment is either immobilization or surgery depending on location of fracture, degree of displacement, and athletic level of patient. Figure A displays her hand during active extension of all fingers. Orthobullets Team Pediatrics - Cavovarus Foot in Pediatrics & Adults Technique Guide. Thank you. normal deltoid ligament. Pediatric proximal femur fractures are rare fractures caused by high-energy trauma and are often associated with polytrauma. Studies. Orthobullets Team Foot & Ankle - Lisfranc Injury; Listen Now 17:18 min. (OBQ05.128) may occur with fracture of the medial malleolus. Temporomandibular joint (TMJ)/jaw assessment. (OBQ11.253) A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. Nonoperative. Second metatarsal base stress fracture. Second metatarsal base stress fracture. (SBQ12FA.79) Keller procedure with lesser metatarsal head resections, 1st MTP joint fusion and lesser metatarsal head resections, 1st MTP joint interposition arthroplasty and lesser MTP joint arthroplasties. What changes should be made to her medication regimen prior to surgery? NB: fracture comminution is not considered in the grading system. spread the metatarsal bones to visualize the webspace, as well as tension the transverse intermetatarsal ligament. metatarsal stress fracture. Perform stress radiographs to assess integrity of the syndesmosis. (SAE07PE.21) 1% (37/3108) 2. NB: fracture comminution is not considered in the grading system. (OBQ12.224) Treatment. Team Orthobullets 4 Foot & Ankle - Turf Toe; Listen Now 12:45 min. On physical exam, he is painful to resisted eversion, resisted plantar flexion of the 1st metatarsal and has a positive Coleman block test. metatarsal stress fracture. All of the following are characteristic of synovium affected by rheumatoid arthritis (RA) EXCEPT: (OBQ05.143) (SBQ12FA.39) 75-year-old woman with long standing rheumatoid arthritis presents with worsening bilateral foot pain. 89% (3285/3693) L 1 Cotton. 2% (68/3108) 5. First branch of the lateral plantar nerve (Baxter's) entrapment. Anterior tarsal tunnel syndrome. First branch of the lateral plantar nerve (Baxter's) entrapment. 5th Metatarsal Base Fracture Metatarsal FX Tarsal Navicular FX external rotation stress test. He is exquisitely tender over the 1st metatarsal. 5% (127/2520) L 2 D Select Answer to see Preferred Response. On physical exam, he is painful to resisted eversion, resisted plantar flexion of the 1st metatarsal and has a positive Coleman block test. Orthobullets Team Foot & Ankle - Lisfranc Injury; Listen Now 17:18 min. On physical examination she has fixed deformities of the metacarpophalangeal (MCP) joints as demonstrated in Figure A. 5th Metatarsal Base Fracture Metatarsal FX any navicular stress fracture, regardless of type, can be initially treated with cast immobilization and nonweight bearing for 6-8 weeks with high rates of success. Galeazzi Fracture - Pediatric stress fractures along the fourth and/or fifth metatarsal bases can develop secondary to repetitive load along the lateral border of the foot. Operative. He is exquisitely tender over the 1st metatarsal. (OBQ13.59) 5.0 (1) See More See Less. A collegiate soccer player presents as a referral to your office after sustaining an injury to the right foot, which he describes as hyperdorsiflexion of the toes. What is the most common complication following surgical fixation for the fracture shown in Figure A in an 8-year-old boy? 5th Metatarsal Base Fracture Metatarsal FX Tarsal Navicular FX external rotation stress test. is usually operative with the technique depending on the age of the patient and the Delbet classification type of fracture. (OBQ11.253) A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. She sees a podiatrist for shaving of her plantar forefoot calluses. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. Metatarsal head osteonecrosis. Which of the following biologic agents commonly used to treat rheumatoid arthritis (RA) DOES NOT target tumor necrosis factor-alpha (TNF-alpha)? A 14-year-old male sustains the injuries shown in Figures A and B after a fall off the roof of his house. Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. MRI. Treatment is either immobilization or surgery depending on location of fracture, degree of displacement, and athletic level of patient. Second metatarsal base stress fracture. 5th Metatarsal Base Fracture gravity stress view can identify medial clear space widening. 5th metatarsal base fractures are common traumatic fractures among athletic populations that are notorious for nonunion due to tenuous blood supply. Smillie Classification. What is the most important consideration in the preoperative evaluation of a child with polyarticular or systemic juvenile rheumatoid arthritis (JRA)? Continue hydroxychloroquine and etanercept, Hold hydroxychloroquine 1 week prior to surgery and continue etanercept, Continue hydroxychloroquine and hold etanercept 1 week prior to surgery, Continue hydroxychloroquine and hold etanercept 2 weeks prior to surgery, Hold hydroxychloroquine and etanercept for 2 weeks prior to surgery. Treatment. A 43-year-old female with long-standing rheumatoid arthritis complains of right forefoot pain for several years. tumors, metabolic bone disease), 30-85% of patients will have associated traumatic injuries, proximal femur develops from 2 centers of ossification, ossification begins at 4-6 months in girls and 5-7 months in boys, responsible for metaphyseal growth of femoral neck, accounts for 13-15% of overall leg length, ossification begins at 4 years in both girls and boys, responsible for appositional growth of greater trochanter, also makes small contribution to growth of femoral neck and intertrochanteric femur, injury to the GT apophysis leads to shortening of the GT and, via the posterosuperior and posteroinferior retinacular branches, at birth, contributes to the blood supply to the head with the LFCA and artery of ligamentum teres, at 4 years old, becomes the main blood supply, at birth, contributes to the blood supply to the head, also contribute to blood supply to the head < 3 years old and after 14-17 years, between 3 to 14-17 years, the physis blocks metaphyseal supply, after 14-17 years, anastomoses between metaphyseal-epiphyseal vessels develop, Transphyseal (with or without epiphyseal dislocation), bone survey if suspected non-accidental trauma, break/offset of bony trabeculae near Ward triangle, indicates nondisplaced or impacted fracture, nondisplaced fractures and stress fractures, nondisplaced fractures and stress fractures (preferred over CT), well-defined low-signal line and surrounding high-signal bone edema on T2-weighted images, difficult to differentiate from effusion due to inflammation or infection, closed reduction and spica abduction casting, Type I without epiphyseal dislocation, II, III, IV IF nondisplaced/minimally displaced AND < 4 years old, evaluate type I fractures for non-accidental trauma if young (< 2-3 years old), vessel injury where large vessel repair is required (rare), concomitant hip or epiphyseal dislocations (especially type I), some data suggests this may decrease the rate of AVN, type I (without epiphyseal dislocation), II, III if displaced and/or > 4 years old, smooth pins may be adequate in young patients if postoperative spica casting performed, cannulated screws in older patients and adolescents, fracture brace or spica cast if there is concern that the long lever arm of the leg could contribute to loss of fixation of the fracture, type I II, III if unable to achieve closed anatomic reduction, consider fracture brace or spica cast if concern for stability of fracture, early reduction (< 24h) may diminish risk of AVN, fracture table (preferred for most patients), can use radiolucent table for younger patients, apply gentle longitudinal traction with abduction and internal rotation, follow with weekly radiographs for 3 weeks to make sure reduction maintained, < 2mm cortical translation, < 5 of angulation, no malrotation, aspiration with large bore needle through subadductor/anterior hip approach, open capsulotomy through anterior incision, type I without epiphyseal dislocation, II, III in patients, older patients close to skeletal maturity (> 12yrs old), when there is little metaphyseal bone available, where crossing the physis is necessary to achieve stable fixation, it is easier to treat leg length discrepancy from premature physeal closure than nonunion, avoid anterolateral quadrant of epiphysis and posterior perforation of femoral neck, post-op spica casting (abduction and internal rotation) for 6-12 weeks if < 4yrs or pin/screw placement short of the physis, long lever arm of the leg could contribute to loss of fixation of the fracture, risk increases 1.14 times for every year of increasing age, highest risk with type I (transphyseal) fractures, type III - area of necrosis in femoral neck from fracture line to physis, young patients (0-3 yrs) will remodel if neck-shaft angle > 110, surgical arrest of trochanteric apophysis, subtrochanteric or intertrochanteric valgus osteotomy, coxa vara with severe Trendelenburg limp or signs/symptoms of FAI, seen in type IV fractures involving GT in younger patients, can occur together with coxa vara (see above), nonoperative treatment of type II or III fractures, ORIF and immobilization (spica cast if younger patient), proximal femoral physis contributes to 15% of overall limb length (3 mm/yr), significant (> 2cm) leg length discrepancy is rare and only occurs in very young children, penetration of physis by fixation devices, significant LLD occurs in combined AVN and physeal arrest, epiphysiodesis of contralateral distal femur proximal tibia, poor vascularity to femoral head cartilage, presents as restricted hip motion, hip pain, radiographic joint space narrowing, deforming forces lead to proximal fragment in flexion, abduction, and external rotation, Poor functional outcomes have been associated with, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). Restart 10 days after. fracture (caused by hyperextension and axial loading), potential avulsion of plantar plate off base of phalanx, sesamoids play important role in function of great toes by, FHB attaches to both tibial and fibular sesamoid, sesamoids are connected to each other by intersesamoid ligament and plantar plate, abductor hallucis is connected to tibial sesamoid, adductor hallucis is connected to fibular sesamoid, sesamoid function is analogous to the patella as they increase the mechanical advantage of the FHB, possible plantar-flexed MTP with cavus foot, helps distinguish a bipartite sesamoid from a fracture, use caution with interpretation as 25%-30% of asymptomatic patients can have increased uptake, increased uptake compared to uninjured side helps diagnosis, keratotic lesion present increasing pressure on sesamoids, nonoperative management fails after 3-12 months, plantar-flexed first ray with sesamoid injury, may be partial or complete sesamoidectomy, removal of both sesamoids is associated with a high incidence of cock-up deformity of the great toe, caused by weakening of the flexor hallucis brevis tendon, which should be meticulously repaired after sesamoid excision, excision of both sesamoids should be avoided, may be caused from tibial sesamoid excision, may be caused by fibular sesamoid excision, Posterior Tibial Tendon Insufficiency (PTTI). Hallux valgus. incision made in line with the tip of the fibula and the base of the 4th metatarsal. Diagnosis can be made with plain radiographs of the hip. 10/15/2019. Pediatric proximal femur fractures are rare fractures caused by high-energy trauma and are often associated with polytrauma. 5th Metatarsal Base Fracture Metatarsal FX any navicular stress fracture, regardless of type, can be initially treated with cast immobilization and nonweight bearing for 6-8 weeks with high rates of success. , with progressive hand and wrist deformity. MRI of the right foot can be seen in Figure A. Freiberg's Infraction. can result in 5th metatarsal stress fractures. Recalcitrant medial sesamoid stress fracture with fragmentation. indications. 10/15/2019. Which of the following images depicts the surgical treatment that would result in the best functional outcome for this patient? Perform stress radiographs to assess integrity of the syndesmosis. You can rate this topic again in 12 months. First metatarsal base stress fracture. 5% Distal 1st metatarsal chevron osteotomy with proximal phalanx Akin procedure. 5th metatarsal base fractures are common traumatic fractures among athletic populations that are notorious for nonunion due to tenuous blood supply. trauma leading to forced external rotation and abduction of ankle. 2% (109/5473) L 2 The patient has palpable pulses, active drainage at the ulcer, and does not have protective sensation with a 5.07 Semmes-Weinstein filament. (OBQ10.263) Inhibition of dihydrofolate reductase (DHFR), Monoclonal antibody against CD20 on B-cell surface. Calcaneal Lengthening Osteotomy Fifth metatarsal fracture. Recalcitrant medial sesamoid stress fracture with fragmentation. 94% (2908/3108) 4. Neoplasm. wide shoe box with firm sole and metatarsal pad . Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. Treatment. Studies. (OBQ09.162) Stress fracture. Plantar fasciitis. Plantar fascia strain. 11/11/2019. 76% (1926/2520) 4. Surgical repair is indicated for patients with progressive and persistent symptoms who fail nonoperative management. The patient has palpable pulses, active drainage at the ulcer, and does not have protective sensation with a 5.07 Semmes-Weinstein filament. Classification. Stress fracture. 5% Distal 1st metatarsal chevron osteotomy with proximal phalanx Akin procedure. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. Plain radiographs of her feet are pictured in Figure A. What is the most appropriate treatment? Treatment is urgent to avoid complication of osteonecrosis, nonunion, and premature physeal closure. pain over syndesmosis is elicited with external rotation/dorsiflexion of the foot with knee and hip flexed to 90 degrees. (OBQ13.169) Immunological testing of anti-cyclic citrullinated peptide antibodies (anti-CCP) is most commonly used for the diagnosis and prognosis of which immunological condition? Team Orthobullets 4 Foot & Ankle - Turf Toe; Listen Now 12:45 min. Classification. Metatarsal head osteonecrosis. 93 plays. Classification. (OBQ10.4) Nonoperative. combination of force and joint positioning causes attenuation or tearing of the plantar capsular-ligamentous complex, tear to capsular-ligamentous-seasmoid complex, tear occurs off the proximal phalanx, not the metatarsal, cartilaginous injury or loose body in hallux MTP joint, articulation between MT and proximal phalanx, abductor hallucis attaches to medial sesamoid, adductor hallucis attaches to lateral sesamoid, attaches to the transverse head of adductor hallucis, flexor tendon sheath and deep transverse intermetatarsal ligament, mechanism of injury consistent with hyper-extension and axial loading of hallux MTP, inability to hyperextend the joint without significant symptoms, comparison of the sesamoid-to-joint distances, often does not show a dislocation of the great toe MTP joint because it is concentrically located on both radiographs, negative radiograph with persistent pain, swelling, weak toe push-off, hyperdorsiflexion injury with exam findings consistent with a plantar plate rupture, persistent pain, swelling, weak toe push-off, used to rule out stress fracture of the proximal phalanx, nonoperative modalities indicated in most injuries (Grade I-III), taping not indicated in acute phase due to vascular compromise with swelling, stiff-sole shoe or rocker bottom sole to limit motion, more severe injuries may require walker boot or short leg cast for 2-6 weeks, progressive motion once the injury is stable, headless screw or suture repair of sesamoid fracture, joint synovitis or osteochondral defect often requires debridement or cheilectomy, abductor hallucis transfer may be required if plantar plate or flexor tendons cannot be restored, immediate post-operative non-weight bearing, treat with cheilectomy versus arthrodesis, depending on severity, Can be a devastating injury to the professional athlete, Posterior Tibial Tendon Insufficiency (PTTI). Plantar fascia strain. This is an AAOS Self Assessment Exam (SAE) question. Classification. Discontinuation of all three medications 1 weeks prior to surgery, Discontinuation of sulfasalazine 1 weeks prior to surgery, continuation of etanercept and penicillamine, Continuation of sulfasalazine, penicillamine, and etanercept, Continuation of sulfasalazine and penicillamine, discontinuation of etanercept 1 week prior to surgery, Continuation of penicillamine, discontinuation of sulfasalazine and etanercept 1 week prior to surgery. 2% (29/1804) 4. What is the next most appropriate treatment for the ring finger? Lumbar radiculopathy. What is the most common surgical complication of resection of both the medial (tibial) and lateral (fibular) hallucal sesamoids on the same foot for intractable keratosis? She has tried orthotics and custom shoes but notes leads to eventual collapse of 2nd MT head. Which of the following statements is true regarding the treatment of this condition? MRI. Treatment. She has tried orthotics and custom shoes but notes (OBQ05.151) A representative coronal MRI sequence at the level of the cuboid is shown in Figure A. Intra-operatively, the peroneal tendon located directly posterior to the fibula is found to be normal. (OBQ12.23) cast immobilization for 8 weeks. Stress fracture. (SBQ18BS.15) grade 1: clean wound <1 cm in length; grade 2: wound 1-10 cm in length without extensive soft-tissue damage, flaps or avulsions; grade 3: extensive soft-tissue laceration (>10 cm) or tissue loss/damage or an open segmental fracture 1% (80/5501) 5. Operative. Nonoperative. Treatment depends on the specific injury to the sesamoid complex, chronicity and patient activity demands. A radiograph is shown in Figure B. Stop 1-2 days before major procedures, restart 1-2 wks after. trauma leading to forced external rotation and abduction of ankle. Which of the following is the best dosing recommendation for her antirheumatic medications prior to surgery? (OBQ07.90) A 45-year-old diabetic male has a Wagner type 3 heel ulcer shown in Figure A that measures 4x2cm and is recalcitrant to debridements and total contact casting for 4 months. Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. Plantar fascia strain. Freiberg's Disease is a rare foot condition characterized by infarction and fracture of the metatarsal head. Neoplasm. Rheumatoid Arthritis is a chronic systemic autoimmune diseasecaused by IgM cell-mediatedimmune response against soft tissues, cartilage, and bone. 10/15/2019. (OBQ11.190) incision made in line with the tip of the fibula and the base of the 4th metatarsal. Excision of the medial sesamoid of the great toe is indicated for which of the following presentations or procedures? Which of the following injuries is associated with highest incidence of osteonecrosis? 1% Inheritance Patterns of Orthopaedic Syndromes, General and Regional Anesthesia in Orthopaedics, Legal Considerations in Orthopaedic Practice. can result in 5th metatarsal stress fractures. Restart 10-14 days after. 85% (1536/1804) 3. 2% (56/3108) 3. high ankle sprain & syndesmosis injury . Orthobullets Team Foot & Ankle - Lisfranc Injury; Listen Now 17:18 min. Medical treatment targeting TNF-alpha has revolutionized which of the following diseases? A 13-year-old female falls and sustains the injury shown in Figure A. TNF antagonists (etanercept, infliximab, adalimumab). He is exquisitely tender over the 1st metatarsal. Which immunoglobulin subtype does the rheumatoid factor target? Calcaneonavicular Ligament (Spring Ligament) Function. A 64-year-old woman with a longstanding history of rheumatoid arthritis complains of finger dysfunction for the past 6 months. Calcaneal Lengthening Osteotomy Fifth metatarsal fracture. high ankle sprain & syndesmosis injury . 5th Metatarsal Base Fracture Metatarsal FX Navicular stress fracture. 1% Infliximab is a medication associated with opportunistic infections in patients with rheumatoid arthritis. This system divides tibial plateau fractures into six types: Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component (generally considered Orthobullets Team Pediatrics - Cavovarus Foot in Pediatrics & Adults Technique Guide. open reduction and internal fixation. Plantar fasciitis. 2-4 cm in length. 1% (80/5501) 5. incision made in line with the tip of the fibula and the base of the 4th metatarsal. Calcaneonavicular Ligament (Spring Ligament) Function. Coupled with first metatarsophalangeal joint arthrodesis for hallux rigidus. Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. used to rule out stress fracture of the proximal phalanx. Turf Toe is a hyperextension injury to the plantar plate and sesamoid complex of the big toe metatarsophalangeal joint that most commonly occurs in contact athletic sports. may occur with fracture of the medial malleolus. An MRI is performed and selected cuts are shown in Figures B and C. What is this patients diagnosis? (OBQ06.111) Dynamic hip screw with trochanteric side plate. tarsal fracture. Team Orthobullets 4 Foot & Ankle - Turf Toe; Listen Now 12:45 min. 1st metatarsophalangeal (MTP) plantar plate reconstruction, 1st metatarsophalangeal (MTP) arthroscopy and debridement, Open reduction internal fixation of sesamoid with autogenous calcaneus bone graft, Distal 1st metatarsal chevron osteotomy with proximal phalanx Akin procedure. pain over syndesmosis is elicited with external rotation/dorsiflexion of the foot with knee and hip flexed to 90 degrees. Cervical rheumatoid spondylitis includes three main patterns of instability, history of prior surgical site infection (SSI), is the most significant risk factor for development of another SSI, the literature is controversial whether RA patients on immunosuppressive therapy have significantly, pharmacologic therapy may need to be changed prior to surgical interventions, surgery should be performed when immunosuppressive agents are at their lowest levels, etanercept should be discontinued 2 week prior to major urgical procedures, adalimumab should be discontinued 10 days prior to surgery, the lowest level of infliximab is found 2 weeks prior to the next scheduled infusion, Significant advances in pharmacologic management have led to a decrease in surgical intervention. 11/11/2019. Anterior tarsal tunnel syndrome. 11/11/2019. 85% (1536/1804) 3. Treatment is urgent to avoid complication of osteonecrosis, nonunion, and premature physeal closure. Cranial migration of the dens from soft tissue erosion and bone loss between occiput and C1&C2, Rupture of flexor pollicis longus in the carpal tunnel, Synovitis in the DRUJ leading to supination of the carpal bones away from the head of the ulna, Rupture of the hand digital extensor tendons, Synovitis of the MTP joints with eventual hyperextension deformity of the MTP. Pediatric proximal femur fractures are rare fractures caused by high-energy trauma and are often associated with polytrauma. indications. 2% (68/3108) 5. (SBQ12FA.39) 5% (127/2520) L 2 D Select Answer to see Preferred Response. On physical exam, he is painful to resisted eversion, resisted plantar flexion of the 1st metatarsal and has a positive Coleman block test. Treatment is nonoperative versus operative based on fracture displacement and alignment, associated soft tissue injury, and patient risk factors. may occur with fracture of the medial malleolus. Classification. Pain is worsened with passive toe extension. Copyright 2022 Lineage Medical, Inc. All rights reserved. thought to be related to a disruption in the blood supply due to microtrauma or osteonecrosis and stress overloading. 85% (1536/1804) 3. grade 1: clean wound <1 cm in length; grade 2: wound 1-10 cm in length without extensive soft-tissue damage, flaps or avulsions; grade 3: extensive soft-tissue laceration (>10 cm) or tissue loss/damage or an open segmental fracture rest, NSAIDS, taping, stiff-sole shoe or walking boot Metatarsal head fracture. She is currently taking sulfasalazine, Penicillamine, and etanercept, a tumor necrosis factor inhibitor (aTNF-a). Plan surgery at the end of dosing +1 week interval (~13 weeks last dose). Proximal Femur Fractures in the pediatric poplulation are rare fractures caused by high-energy trauma and are often associated with polytrauma. (OBQ11.253) A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. cast immobilization for 8 weeks. Restart >14 days postoperatively. 89% (3285/3693) L 1 Plantar fasciitis. She presents for her preoperative visit and asks about dosing of her antirheumatic medications. MTPJ arthritis. indications. Cotton. Treatment is urgent to avoid complication of osteonecrosis, nonunion, and premature physeal closure. 2% (109/5473) L 2 The patient notes worsening pain at the toe-off phase of gait. Nonoperative. Vaughan-Jackson syndrome in rheumatoid arthritis is best described as? Anterior tarsal tunnel syndrome. Coupled with first metatarsophalangeal joint arthrodesis for hallux rigidus. Thank you. Only when nonoperative treatment fails is surgical reconstruction indicated. A 64-year-old female with rheumatoid arthritis has decreased functional use of the left hand for activities of daily living. 2% (109/5473) L 2 Freiberg's Infraction. First metatarsal base stress fracture. Nonoperative. She has tried orthotics and custom shoes but notes Smillie Classification. Treatment. pain over syndesmosis is elicited with external rotation/dorsiflexion of the foot with knee and hip flexed to 90 degrees. cast immobilization for 8 weeks. Hunter syndrome (type II mucopolysaccharidosis), 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Hand Manifestation of Rheumatoid Arthritis - Michael Firtha, DO, Arthrodesis & Arthroplasty of Small Joints of the Hand - Shaan Patel, MD, Cleveland Combined Hand Fellowship Lecture Series 2019-2020, Small Joints Arthroplasty vs Arthrodesis - Imad Abushahin, MD, Basic Science | Rheumatoid Arthritis of the Elbow (ft. Dr. Matthew L. Ramsey), Hip pain with an unusual pelvic XRay in a 68M. 5.0 (1) See More See Less. 5% Distal 1st metatarsal chevron osteotomy with proximal phalanx Akin procedure. NB: fracture comminution is not considered in the grading system. Which of the following management options for the finger MCP joints most likely lead to the least amount of extensor lag and improvement of the ulnar drift at 1-year followup? Treatment is nonoperative versus operative based on fracture displacement and alignment, associated soft tissue injury, and patient risk factors. 2% (56/3108) 3. 2% (29/1804) 4. 1% (37/2520) 5. An AP radiograph is shown in FIgure A. Treatment is either immobilization or surgery depending on location of fracture, degree of displacement, and athletic level of patient. 93 plays. 56% (1135/2011) 5th Metatarsal Base Fracture Metatarsal FX Navicular stress fracture. Gustilo-Anderson classification. Hallux valgus. 69-year-old male with a valgus impacted three-part proximal humerus fracture, 89-year-old female with a valgus impacted (Garden I) femoral neck fracture, 14-year-old male with a displaced distal femoral physeal fracture, 13-year-old female with a displaced transcervical femoral neck fracture, 42-year-old male with a closed 5th metatarsal fracture at the metaphyseal-diaphyseal junction. Nonoperative. 12% (235/2011) 3. 2-4 cm in length. rest, NSAIDs, taping, stiff-sole shoe, or walking boot in the majority of cases. Hallux valgus. Treatment usually includes a period of immobilization followed by physical therapy. What is the mechanism of action of Infliximab? Neoplasm. Diagnosis is made clinically with the inability to hyperextend the hallux MTP joint without significant pain and the inability to push off with the big toe. (SBQ13PE.52) 56% (1135/2011) Percutaneous pinning of the physeal fracture and long leg cast placement. A 32-year-old female avid triathlete complains of left plantar great toe pain for the past 4 months. Figure B displays her hand maintaining her fingers extended following passive extension. Stress fracture. In the treatment of patients with rheumatoid arthritis, TNF-alpha is blocked by which of the following agents? high ankle sprain & syndesmosis injury . Treatment. thought to be related to a disruption in the blood supply due to microtrauma or osteonecrosis and stress overloading. 5% (127/2520) L 2 D Select Answer to see Preferred Response. MTPJ arthritis. wide shoe box with firm sole and metatarsal pad . Orthobullets Team Pediatrics - Cavovarus Foot in Pediatrics & Adults Technique Guide. 56% (1135/2011) 1% (37/2520) 5. (OBQ09.274) Copyright 2022 Lineage Medical, Inc. All rights reserved. 5th Metatarsal Base Fracture Metatarsal FX any navicular stress fracture, regardless of type, can be initially treated with cast immobilization and nonweight bearing for 6-8 weeks with high rates of success. MRI of the right foot can be seen in Figure A. IP fusion and MCP arthroplasty (if CMC is diseased), Boutonniere with CMC subluxation (uncommon, deformity primarily at CMC), Swan neck deformity (MCP hyperextension, IP flexion), Stage 3: MCP fusion with first web release, Gamekeeper deformity (metacarpal adduction, radial deviation of P1 with lax volar plate and UCL), Stage 1 (passively correctable): synovectomy, UCL reconstruction, and adductor fascia release, Stage 2 (fixed deformity) MP arthroplasty or fusion, Swan neck with MCP disease (MCP volar plate laxity), MP stabilized in flexion by volar capsulodesis, Skeletal collapse (arthritis mutilans) (MCP volar plate laxity), FDS4 to FPL tendon transfer + excision of scaphoid spurs (may also lead to rupture index FDP2), frequency EDM > EDC (ring) > EDC (small) > EPL, extensor tendons migrate slip into ulnar gutter and volar to center of rotation of MCP joint, if MCP placed in extension actively then patient can hold extended, sagittal band reconstruction (extensor hood reconstruction), rupture of digital extensor tendons from ulnar to radial, DRUJ instability + volar carpal subluxation results in dorsal ulnar head prominence and attritional rupture of the extensor tendons, Differentials for loss of digital extension, extensor tendon subluxation (torn radial sagittal band), to EDC5 or EDQM to EDC piggyback transfer, must also relocate ECU dorsally with a retinacular flap or perform ECU stabilization of ulna, synovitis and capsular distension leads to, ulnar and volar translocation of the carpus on the radius, with scaphoid flexion, radiolunate widening, lunate translocation (ulnarwards), ulnar deviation of the fingers at the MP joints creating the classic zigzag deformity, transfer of ECRL to ECU to diminish deforming forces (Clayton's procedure), advantages over fusion is motion and best in patients with reasonable motion preop, rheumatoid elbow is mainly managed with medical management and cortisone injections, focus of degeneration is in radiohumeral joint, posterior interosseous nerve compression secondary to radial head synovitis, performed through lateral approach to elbow, young active patients who are not candidates of TEA, resection and contouring of humeral surface, cover humeral surface with cutis autograft, Achilles tendon, fascia, or dermal allograft, some use distraction external fixator to unload membrane and enhance its bonding to bone and improve motion, results less predictable than TEA, but avoids prosthetic complications, reliable procedure for advanced RA of elbow, 5 lb single arm weight lifting restriction, RA is most prevalent form of inflammatory process affecting the shoulder with >90% developing shoulder symptoms, commonly associated with rotator cuff tears, decreases pain and swelling but does not alter prevent radiographic progression and does not prevent the need for TKA in the future, normal synovium reforms, but degenerates to rheumatoid synovium over time, rheumatoid arthritis is considered an indication for resurfacing of the patella during total knee arthroplasty, forefoot joints are the first to be affected, human leukocyte antigen (HLA)-DR4 positive. spread the metatarsal bones to visualize the webspace, as well as tension the transverse intermetatarsal ligament. used to rule out stress fracture of the proximal phalanx. 1% (OBQ07.90) A 45-year-old diabetic male has a Wagner type 3 heel ulcer shown in Figure A that measures 4x2cm and is recalcitrant to debridements and total contact casting for 4 months. Diagnosis is made with a combination of physical examination, characteristic radiographs, and labs to evaluate for presence of RF andanti-CCP antibodies. First metatarsal base stress fracture. Classification. Rheumatoid factor does not target an immunoglobulin. (OBQ12.137) Which of the following medications specifically target tumor necrosis factor alpha (TNF-a)? (OBQ10.83) Perform stress radiographs to assess integrity of the syndesmosis. Lumbar radiculopathy. Gustilo-Anderson classification. Treatment usually includes a period of immobilization followed by physical therapy. MTPJ arthritis. 76% (1926/2520) 4. She sees a podiatrist for shaving of her plantar forefoot calluses. Treatment. (OBQ10.93) 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Foot & AnkleSesamoid Injuries of the Hallux. Continue for minor procedures. MRI. Freiberg's Infraction. Treatment. 94% (2908/3108) 4. This system divides tibial plateau fractures into six types: Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component (generally considered 76% (1926/2520) 4. MRI of the right foot can be seen in Figure A. First branch of the lateral plantar nerve (Baxter's) entrapment. (OBQ18.99) Metatarsal head osteonecrosis. Treatment may be casting or operative depending on the age of the patient and the type of fracture. Clinically significant limb length discrepancy, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, PediatricsProximal Femur Fractures (ft. Dr. Lindsay Andras), Question SessionPediatric Proximal Femur Fractures & Proximal Third Tibia Fractures, PediatricsProximal Femur Fractures - Pediatric. She currently takes etanercept weekly and hydroxychloroquine daily. Spiral oblique retinacular ligament reconstruction, Triangular ligament and transverse retinacular ligament reconstruction. the earliest manifestation of rheumatoid arthritis of the forefoot is synovitis of the MTP joints with eventual hyperextension deformity of the MTP joints including distal migration of the forefoot pad, painful plantar callosities and skin ulcerations over bony prominences. Treatment may be casting or operative depending on the age of the patient and the type of fracture. (OBQ18.111) 2-4 cm in length. wide shoe box with firm sole and metatarsal pad . spread the metatarsal bones to visualize the webspace, as well as tension the transverse intermetatarsal ligament. (OBQ06.113) open reduction and internal fixation. children < 2-3 years old due to non-accidental trauma, adolescents involved in motor vehicle accidents, can result from low-energy trauma if the patient has weakened bone (i.e. Treatment usually includes a period of immobilization followed by physical therapy. A 45-year-old woman with rheumatoid arthritis is being scheduled for a total knee athroplasty in 2 weeks. 89% (3285/3693) L 1 Ankle sprains involve an injury to the ATFL and CFL and are the most common reason for missed athletic participation. (OBQ07.90) A 45-year-old diabetic male has a Wagner type 3 heel ulcer shown in Figure A that measures 4x2cm and is recalcitrant to debridements and total contact casting for 4 months. 1% (37/3108) 2. rest, NSAIDS, taping, stiff-sole shoe or walking boot Metatarsal head fracture. 1% (80/5501) 5. Percutaneous pinning of the physeal fracture and long leg cast placement. Avertical Lachman test will show greater laxity compared to the contralateral side. open reduction and internal fixation. Coupled with Lapidus procedure for hallux valgus, Recalcitrant medial sesamoid stress fracture with fragmentation, Coupled with first metatarsophalangeal joint arthrodesis for hallux rigidus. (OBQ13.254) (OBQ09.179) normal deltoid ligament. Nonoperative. used to rule out stress fracture of the proximal phalanx. Freiberg's Disease is a rare foot condition characterized by infarction and fracture of the metatarsal head. Recalcitrant medial sesamoid stress fracture with fragmentation. She sees a podiatrist for shaving of her plantar forefoot calluses. She has failed conservative management. Ankle sprains involve an injury to the ATFL and CFL and are the most common reason for missed athletic participation. 94% (2908/3108) 4. You can rate this topic again in 12 months. Patients present with insidious onset ofmorning joint stiffness, polyarthropathy. Gustilo-Anderson classification. Stage 1. 1% (37/2520) 5. 1% (37/3108) 2. 2% (56/3108) 3. Treatment. What is the most appropriate management? Stage 1. (SBQ12FA.39) 75-year-old woman with long standing rheumatoid arthritis presents with worsening bilateral foot pain. Acute medial sesamoid fracture. Copyright 2022 Lineage Medical, Inc. All rights reserved. Treatment is nonoperative versus operative based on fracture displacement and alignment, associated soft tissue injury, and patient risk factors. Coupled with first metatarsophalangeal joint arthrodesis for hallux rigidus. You can rate this topic again in 12 months. She has tried orthotics and custom shoes but notes worsening foot pain that is limiting her daily activities. Stress fracture. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, 2019 Orthopaedic Summit Evolving Techniques, He Is Playing With Nonoperative Treatment - Michael Coughlin, MD, He Is Out! Sesamoid injuries of the Hallux consist of a constellation of injuries to the sesamoid complex consisting of fractures, tendonitis, and ligamentous injuries. This system divides tibial plateau fractures into six types: Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component (generally considered Treatment may be casting or operative depending on the age of the patient and the type of fracture. Examination reveals a well-aligned foot with ecchymosis and swelling on the plantar aspect of the 1st MTP joint. metatarsal stress fracture. leads to eventual collapse of 2nd MT head. 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