Questions and Answers
What is the next best step in treatment for posttraumatic elbow stiffness?
Static or dynamic progressive elbow splinting with a turnbuckle
What is the radiographic hallmark of Paget's disease?
Enlargement of a vertebral body
Which type of total elbow arthroplasty (TEA) is expected to have the longest implant survivorship in patients?
Semiconstrained TEA in RA patients
What does the winking owl sign indicate?
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What is the most common site of subsequent pathologic fracture when lung cancer metastasizes to bone?
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What is the power of a study?
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What does effect size estimate?
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What is variance?
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What is a confidence interval?
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What is a P value?
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What does treatment for osteosarcoma generally include?
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What does 175 cc of fluid injected into the knee joint predict?
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When is the medial ulnar collateral ligament subjected to the greatest tensile stress?
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What conditions are associated with fibular hemimelia?
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What are the types of tibial bowing?
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Study Notes
Post-Traumatic Elbow Stiffness
- Objective of treatment: Restore functional elbow motion (30° to 130°).
- Non-operative treatment is first-line; includes aggressive physical therapy.
- Static or dynamic progressive elbow splinting with a turnbuckle shows superior functional outcomes.
- Treatment duration typically spans 6 to 12 months.
- Surgical intervention is considered if non-operative therapy fails.
Paget’s Disease
- Radiographic hallmark: Enlargement of the vertebral body.
- Characterized by diffuse thickening of cortical bone.
- Imaging shows low T1 and high T2 signal alteration of the bone while preserving bone marrow.
- Thickened cortex is termed "picture frame vertebral body."
Total Elbow Arthroplasty (TEA) Survivorship
- Semiconstrained TEA is associated with longest implant survivorship in patients with rheumatoid arthritis (RA).
Winking Owl Sign
- Absent pedicle sign indicative of spinal pathologies.
- Associated conditions include spinal metastases, intraspinal malignancies, tuberculosis, and other infections.
- Rarely, it may be related to primary bone lesions, such as lymphoma.
Pathologic Fractures from Lung Cancer Metastases
- Most common skeletal site for metastatic disease: Spine.
- Proximal femur is the most frequent site for pathologic fractures secondary to bone metastases.
- Vulnerability of the proximal femur stems from stress risers making it prone to fracture.
Study Power
- Defined as the likelihood of detecting a statistically significant difference between two groups, given a real difference exists.
- Power formula: power = 1 - β; with adequate power considered to be greater than 80%.
- Power analysis determines minimum patient numbers required for clinically significant outcomes; should be established before the study begins.
Effect Size
- Represents the estimated magnitude of difference in means between two groups.
Variance
- The average of the squared deviations of each value from the mean, indicating data dispersion.
Confidence Interval
- A probable range within which the true population value lies.
P Value
- Denotes the probability of obtaining results as extreme or more than observed if the null hypothesis is true.
Osteosarcoma Treatment
- Recommended treatment encompasses neoadjuvant chemotherapy, surgical excision with reconstruction, and adjuvant chemotherapy.
Knee Joint Fluid Injection
- Injection of 175 cc of fluid into the knee predicts a 99% accuracy for inferolateral traumatic arthrotomies.
Medial Ulnar Collateral Ligament Stress
- Greatest tensile stress occurs during the late cocking to early acceleration phases of throwing.
Fibular Hemimelia Associations
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Hip Conditions:
- Most common is femoral shortening (50% incidence).
- Others include PFFD and developmental dysplasia of the hip (DDH), and coxa vara.
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Knee Conditions:
- Hypoplastic lateral femoral condyle, genu valgum, and absent or deficient cruciate ligaments.
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Tibia:
- Characterized by anterior medial bowing (apex anterior and medial).
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Foot and Ankle Issues:
- Includes ball and socket ankle, tarsal coalition (50% incidence), and absent lateral rays.
Types of Tibial Bowing
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Anterior-Lateral & Anterior-Medial:
- Often associated with neurofibromatosis type I (diaphyseal pseudoarthrosis) and fibular hemimelia.
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Posterior-Medial:
- Springs from physiological variations.
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Description
Test your knowledge on the management of post-traumatic elbow stiffness related to radial head fractures. This quiz focuses on clinical diagnosis and treatment options following injury. Perfect for medical professionals and students preparing for exams.