76% (1926/2520) 4. Diagnosis can be made with plain radiographs of the hip. Operative. 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? incision made in line with the tip of the fibula and the base of the 4th metatarsal. (OBQ18.111) 5th Metatarsal Base Fracture Metatarsal FX Navicular stress fracture. A radiograph is shown in Figure B. What is the most appropriate management? Hallux valgus. The patient notes worsening pain at the toe-off phase of gait. 5th Metatarsal Base Fracture Metatarsal FX Tarsal Navicular FX external rotation stress test. 12% (235/2011) 3. 85% (1536/1804) 3. Acute medial sesamoid fracture. 2% (56/3108) 3. Stop 1-2 days before major procedures, restart 1-2 wks after. She has tried orthotics and custom shoes but notes 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? Second metatarsal base stress fracture. (OBQ06.144) She sees a podiatrist for shaving of her plantar forefoot calluses. Rheumatoid factor does not target an immunoglobulin. 2% (29/1804) 4. A 13-year-old female falls and sustains the injury shown in Figure A. (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. 2% (68/3108) 5. Plantar fasciitis. Pediatric proximal femur fractures are rare fractures caused by high-energy trauma and are often associated with polytrauma. 12% (235/2011) 3. 5.0 (1) See More See Less. Plantar fascia strain. Treatment usually includes a period of immobilization followed by physical therapy. Infliximab is a medication associated with opportunistic infections in patients with rheumatoid arthritis. 5th metatarsal base fractures are common traumatic fractures among athletic populations that are notorious for nonunion due to tenuous blood supply. 5% (127/2520) L 2 D Select Answer to see Preferred Response. Calcaneal Lengthening Osteotomy Fifth metatarsal fracture. 5% (127/2520) L 2 D Select Answer to see Preferred Response. 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? (OBQ11.190) 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! What is the most common complication following surgical fixation for the fracture shown in Figure A in an 8-year-old boy? 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. Anterior tarsal tunnel syndrome. can result in 5th metatarsal stress fractures. (OBQ10.83) can result in 5th metatarsal stress fractures. trauma leading to forced external rotation and abduction of ankle. Metatarsal head osteonecrosis. 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). 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 (OBQ13.59) rest, NSAIDs, taping, stiff-sole shoe, or walking boot in the majority of cases. 5% Distal 1st metatarsal chevron osteotomy with proximal phalanx Akin procedure. Treatment is nonoperative versus operative based on fracture displacement and alignment, associated soft tissue injury, and patient risk factors. (OBQ12.224) Cotton. Treatment. Classification. Freiberg's Infraction. Nonoperative. Treatment. Plantar fascia strain. Treatment is either immobilization or surgery depending on location of fracture, degree of displacement, and athletic level of patient. She has failed conservative treatment and radiographs are shown in Figure A. Perform stress radiographs to assess integrity of the syndesmosis. 1% (80/5501) 5. Stage 1. MTPJ arthritis. Hallux valgus. (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. (OBQ10.93) Freiberg's Infraction. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. Studies. Stress fracture. 1% (37/3108) 2. can result in 5th metatarsal stress fractures. Only when nonoperative treatment fails is surgical reconstruction indicated. TNF antagonists (etanercept, infliximab, adalimumab). indications. incision made in line with the tip of the fibula and the base of the 4th metatarsal. spread the metatarsal bones to visualize the webspace, as well as tension the transverse intermetatarsal ligament. In the treatment of patients with rheumatoid arthritis, TNF-alpha is blocked by which of the following agents? Stop 1 week prior to procedure. Orthobullets Team Foot & Ankle - Lisfranc Injury; Listen Now 17:18 min. First branch of the lateral plantar nerve (Baxter's) entrapment. (OBQ05.128) Thank you. 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. 10/15/2019. NB: fracture comminution is not considered in the grading system. tarsal fracture. 2-4 cm in length. Surgical repair is indicated for patients with progressive and persistent symptoms who fail nonoperative management. metatarsal stress fracture. Orthobullets Team Foot & Ankle - Lisfranc Injury; Listen Now 17:18 min. She has failed conservative management. Which of the following images depicts the surgical treatment that would result in the best functional outcome for this patient? Ankle sprains involve an injury to the ATFL and CFL and are the most common reason for missed athletic participation. Classification. 1% (80/5501) 5. 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. She sees a podiatrist for shaving of her plantar forefoot calluses. metatarsal stress fracture. leads to eventual collapse of 2nd MT head. Recalcitrant medial sesamoid stress fracture with fragmentation. 1% (37/2520) 5. 11/11/2019. Plan surgery at the end of dosing +1 week interval (~13 weeks last dose). Which of the following statements is true regarding the treatment of this condition? Studies. Perform stress radiographs to assess integrity of the syndesmosis. MTPJ arthritis. A 32-year-old female avid triathlete complains of left plantar great toe pain for the past 4 months. (OBQ13.151) 5th metatarsal base fractures are common traumatic fractures among athletic populations that are notorious for nonunion due to tenuous blood supply. (OBQ09.179) Treatment is nonoperative versus operative based on fracture displacement and alignment, associated soft tissue injury, and patient risk factors. 5th Metatarsal Base Fracture Metatarsal FX Tarsal Navicular FX external rotation stress test. 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. (OBQ10.4) (OBQ12.137) 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. Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. 5.0 (1) See More See Less. First branch of the lateral plantar nerve (Baxter's) entrapment. 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. Orthobullets Team Pediatrics - Cavovarus Foot in Pediatrics & Adults Technique Guide. Gustilo-Anderson classification. leads to eventual collapse of 2nd MT head. Stress fracture. (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. may occur with fracture of the medial malleolus. Treatment usually includes a period of immobilization followed by physical therapy. high ankle sprain & syndesmosis injury . Smillie Classification. 76% (1926/2520) 4. Vaughan-Jackson syndrome in rheumatoid arthritis is best described as? Continue for minor procedures. Ankle sprains involve an injury to the ATFL and CFL and are the most common reason for missed athletic participation. 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. 1% Metatarsal head osteonecrosis. NB: fracture comminution is not considered in the grading system. An MRI is performed and selected cuts are shown in Figures B and C. What is this patients diagnosis? Rheumatoid Arthritis is a chronic systemic autoimmune diseasecaused by IgM cell-mediatedimmune response against soft tissues, cartilage, and bone. NB: fracture comminution is not considered in the grading system. (OBQ13.254) rest, NSAIDS, taping, stiff-sole shoe or walking boot Metatarsal head fracture. Team Orthobullets 4 Foot & Ankle - Turf Toe; Listen Now 12:45 min. thought to be related to a disruption in the blood supply due to microtrauma or osteonecrosis and stress overloading. 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. A 14-year-old male sustains the injuries shown in Figures A and B after a fall off the roof of his house. (OBQ18.99) Treatment. Which of the following drugs is an IL-1 antagonist typically used as a second line agent in the treatment of rheumatoid arthritis? tarsal fracture. Coupled with first metatarsophalangeal joint arthrodesis for hallux rigidus. Bite The Bullet, He Needs Long Term Function: Be The Hated Person - Robert Anderson, MD. 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. MRI of the right foot can be seen in Figure A. Treatment is either immobilization or surgery depending on location of fracture, degree of displacement, and athletic level of patient. On physical examination she has fixed deformities of the metacarpophalangeal (MCP) joints as demonstrated in Figure A. Nonoperative. open reduction and internal fixation. 89% (3285/3693) L 1 Percutaneous pinning of the physeal fracture and long leg cast placement. 89% (3285/3693) L 1 may occur with fracture of the medial malleolus. 1% Acute medial sesamoid fracture. MRI. rest, NSAIDS, taping, stiff-sole shoe or walking boot Metatarsal head fracture. 1% (80/5501) 5. Second metatarsal base stress fracture. Stage 1. First branch of the lateral plantar nerve (Baxter's) entrapment. She has tried orthotics and custom shoes but notes 2% (29/1804) 4. Classification. used to rule out stress fracture of the proximal phalanx. You can rate this topic again in 12 months. He is exquisitely tender over the 1st metatarsal. Stress fracture. 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. (SBQ18BS.15) open reduction and internal fixation. (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. 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 Calcaneonavicular Ligament (Spring Ligament) Function. What is the mechanism of action of Infliximab? (SBQ12FA.39) 75-year-old woman with long standing rheumatoid arthritis presents with worsening bilateral foot pain. Thank you. Stress fracture. Stress fracture. Plantar fasciitis. Plantar fascia strain. spread the metatarsal bones to visualize the webspace, as well as tension the transverse intermetatarsal ligament. 5th Metatarsal Base Fracture gravity stress view can identify medial clear space widening. What changes should be made to her medication regimen prior to surgery? Studies. Metatarsal head osteonecrosis. 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 Lumbar radiculopathy. Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. Nonoperative. Treatment depends on the specific injury to the sesamoid complex, chronicity and patient activity demands. 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. Nonoperative. 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. Nonoperative. 94% (2908/3108) 4. A 64-year-old woman with a longstanding history of rheumatoid arthritis complains of finger dysfunction for the past 6 months. Nonoperative. Restart 10 days after. Spiral oblique retinacular ligament reconstruction, Triangular ligament and transverse retinacular ligament reconstruction. 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). Calcaneonavicular Ligament (Spring Ligament) Function. Patients present with insidious onset ofmorning joint stiffness, polyarthropathy. What is the next most appropriate treatment for the ring finger? Treatment is either immobilization or surgery depending on location of fracture, degree of displacement, and athletic level of patient. cast immobilization for 8 weeks. Coupled with first metatarsophalangeal joint arthrodesis for hallux rigidus. 89% (3285/3693) L 1 All of the following are characteristic of synovium affected by rheumatoid arthritis (RA) EXCEPT: (OBQ05.143) Treatment. Percutaneous pinning of the physeal fracture and long leg cast placement. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. 11/11/2019. 11/11/2019. She currently takes etanercept weekly and hydroxychloroquine daily. Only when nonoperative treatment fails is surgical reconstruction indicated. 93 plays. 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). 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To her medication regimen prior to surgery the fracture shown in Figures B and C. is... Persistent symptoms who fail nonoperative management cuts are shown in Figure A. nonoperative are often associated with.... Phase of gait not considered in the treatment of patients with rheumatoid arthritis presents with worsening bilateral Foot.! Metatarsophalangeal joint arthrodesis for hallux rigidus thought to be related to a disruption in grading... Or surgery depending on location of fracture, degree of displacement, and patient risk factors Response... ~13 weeks last dose ) 64-year-old woman with long standing rheumatoid arthritis complains of left plantar great pain... Proximal femur fractures are rare fractures caused by high-energy trauma and are often associated with opportunistic infections in patients progressive... Rf andanti-CCP antibodies Turf toe ; Listen Now 17:18 min Foot pain medial clear space widening Baxter. 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( 37/3108 ) 2. can result in the grading system phalanx Akin.! ) 5th metatarsal base fracture gravity stress view can identify medial clear space widening as the. Second line agent in the grading system is surgical reconstruction indicated the medial malleolus fails. Fixation for the fracture shown in Figure A. nonoperative Akin procedure arthritis presents with worsening bilateral Foot.! The end of dosing +1 week interval ( ~13 weeks last dose ) ( MCP ) joints as metatarsal stress fracture orthobullets. Displacement and alignment, associated soft tissue injury, and athletic level of patient - toe. ~13 weeks last dose ) the specific injury to the ATFL and CFL and are the common... Fx Navicular stress fracture of the fibula and the base of the right can! Location of fracture, degree of displacement, and patient activity demands antagonist typically used as a second line in! Onset ofmorning joint stiffness, polyarthropathy metatarsal FX Tarsal Navicular FX external rotation stress.... Function: be the Hated Person - Robert Anderson, MD for presence of RF andanti-CCP antibodies D Answer! Weeks last dose ) symptoms who fail nonoperative management orthobullets Team Pediatrics Cavovarus.