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ORTHOBULLETS

Orthopedic Resident - USA, 2013. Increase your OITE scores by having access to both Academy SAE questions and Orthobullets Virtual Curriculum questions. Identify your areas of strength and weakness with our monthly diagnostic Milestone exams. Enjoy unlimited access to our study plans, including OITE and CORE Curriculum. ACROMIOCLAVICULAR JOINT INJURY Description. a acromioclavicular joint injury, otherwise known as a shoulder separation, is a traumatic injury to the acromioclavicular (AC) joint with disruption of the acromioclavicular ligaments and/or coracoclavicular (CC) ligaments. treatment is immobilzation or surgical reconstruction depending on the degree of separation and

ligament injury.

DISTAL RADIUS FRACTURES distal radius (and ulna) is the most common site of pediatric forearm fractures. male > female (male 2-3 times more common than female) demographics. most common during metaphyseal growth spurt. peak incidence occurring from: 10-12 years of age in girls. 12-14 years of age in boys. most common fracture in children under 16 years old. PEDIATRIC SPONDYLOLYSIS & SPONDYLOLISTHESIS Pediatric Spondylolysis & Spondylolisthesis. Pediatric spondylolysis & spondylolisthesis represent a continuum of disease where there is a fracture of the pars interarticularis (spondylolysis) which may progress to malalignment of adjacent vertebral bodies (spondylolisthesis).

ANKLE SPRAIN

Ankle sprains involve an injury to the ATFL and CFL and are the most common reason for missed athletic participation. Treatment usually includes a period of immobilization followed by physical therapy. Only when nonoperative treatment fails is surgical reconstruction

indicated.

TRIQUETRUM FRACTURE

Triquetrum Fracture. Triquetrum fractures are common carpal fractures that are often associated with other injuries to the wrist. Diagnosis is confirmed with orthogonal views of the wrist. Treatment is generally nonoperative but injuries associated with wrist instability require surgical fixation. results from shearing of proximal edge of

the

PATELLAR INSTABILITY Summary. Patellar instability is a condition characterized by patellar subluxation or dislocation episodes as a result of injury, ligamentous laxity or increased Q angle of the knee. Diagnosis is made clinically in the acute setting with a patellar dislocation with a traumatic knee effusion and in chronic settings with passive patellar MOREL-LAVALLEE LESION A Morel-Lavallee Lesion (MLL) is a closed traumatic soft tissue degloving injury characterized by separation of the dermis from the underlying fascia due to a shearing force. Diagnosis requires high a index of suspicion with presence of an area of ecchymosis, swelling, fluctuance and skin hypermobility in the polytrauma patient with

underlying

HAMSTRING INJURIES

Hamstring injuries most commonly occur at the myotendinous junction in running athletes as a result of sudden hip flexion and knee extension. Diagnosis can be made clinically with ecchymosis in the posterior thigh, tenderness over the hamstring muscles and avoidance of knee extension. Diagnosis can be confirmed with MRI.

HIP OSTEONECROSIS

ORTHOBULLETS

ligament injury.

ANKLE SPRAIN

indicated.

TRIQUETRUM FRACTURE

the

underlying

HAMSTRING INJURIES

HIP OSTEONECROSIS

TOPICS

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ANKLE FRACTURES

suspect injury in all ankle fractures. most common in Weber C fracture patterns. fixation usually not required when fibula fracture within 4.5 cm of plafond. up to 25% of tibial shaft fractures will have ankle injury (highest rate with distal 1/3 spiral fractures) Evaluation. measure clear space 1 cm above joint.

SEARCH EVIDENCE

Mutation screening of EXT1 and EXT2 by denaturing high-performance liquid chromatography, direct sequencing analysis, fluorescence in situ hybridization, and a new multiplex ligation-dependent probe amplification probe set in patients with multiple osteochondromas.

SEARCH EVIDENCE

Semin Arthritis Rheum. 2014 Jun;43(6):738-44. Epub 2013 Dec 12. Cervical spine involvement early in the course of rheumatoid

arthritis.

RADIAL HEAD FRACTURES radial head fractures are among the most common elbow fractures (33%) Pathophysiology. mechanism of injury. fall on outstretched hand. elbow in extension + forearm in pronation. most force transmitted from wrist to radial head. Associated injuries. 35% have BOTH BONE FOREARM FRACTURE Symptoms. forearm pain and refuses to use arm. Physical exam. inspection. swelling, deformity, and ecchymosis. open fracture. can be subtle poke-holes, and can often be missed if not evaluated by an orthopedic surgeon. tenderness to palpation. a complete examination of

HIP OSTEONECROSIS

(OBQ11.196) A 47-year-old man presents with 1 week of left leg pain. 6 months prior he underwent a vascularized free-fibula bone graft from his left leg to his right hip for avascular necrosis. The pain is located at the level of his donor site and is worse with weight-bearing and relieved by rest. Physical exam shows focal tenderness over his tibia. SNAPPING EXTENSOR CARPI ULNARIS (ECU) Snapping Extensor Carpi Ulnaris (ECU) Snapping ECU is a clinical condition characterized by pain over the ulnar wrist caused by instability and tendonitis of the ECU tendon secondary overuse. Diagnosis is made with clinical examination with palpation of the ECU tendon and noting a painful snap while moving the wrist from pronation

to supination.

CEREBRAL PALSY

starts as dynamic contractures, become static with time (continuous muscle contraction results in shortening) and growth (growth of bones occurs at a faster longitudinal rate than muscles in spastic cerebral palsy) upper extremity deformities. hip ADOLESCENT IDIOPATHIC SCOLIOSIS Defined as idiopathic scoliosis in children 10 to 18 yrs. most common type of scoliosis. Epidemiology. incidence of 3% for curves between 10 to 20°. incidence of 0.3% for curves > 30°. 10:1 female to male ratio for curves > 30°. 1:1 male to female ratio for

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HOW PEAK HELPS YOU LEARN MORE EFFICIENTLY Click the PEAK Tracker below to see how you rate mastery of different learning activities.

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20%

Topic

2|0

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12%

Questions

0|0

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5%

Evidence

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50%

Cases

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12%

Videos

0|0

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24%

Skill Tasks

2|1

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10%

Self Mastery

15|212

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1.5 Faculty

13|57

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REVIEW TOPICS

Memorizing topics lays the foundation of knowledge needed to eventually apply knowledge and think critically. Learning topics is best accomplished in layers. As a junior resident you should focus on presentation and nonoperative treatment. As a senior resident you should focus more on operative treatment, techniques, and

complications.

TARGET CONTENT: Orthobullets Review Topics. Does not include Technique Guides or Approaches, as that is captured under the Skill component of

Peak.

MASTERY TRIGGER: Click on the Topic Selfmastery wheel to advance based

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Have never seen topic

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Skimmed the topic briefly once

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Skimmed the topic briefly and skimmed 50% of questions once

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Read entire topic and did all questions once

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Read entire topic and did all questions at least twice

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Presented topic to other residents or taught at grand rounds

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QUESTIONS

Questions are a "poor-mans" version of case-based learning, which is the best way to learn to apply medical knowledge, evidence, and to think critically. Questions work best in repetition, where you see the question over and over again, going deeper into the explanation and

references.

TARGET CONTENT: Orthobullets and AAOS SAE Questions. We recognize some of the AAOS SAE questions are dated and need improvement. However, we still think they should be taken as they included valuable tested concepts. Even if the correct answer is outdated, it is important to know that historically a condition was treated differently - a question can still be a great educational tool even though it is a "bad question" from a diagnostic perspective. MASTERY TRIGGER: Click on Selfmastery wheel for EACH OB and SAE Question associated with the topic to advance based on scale below

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Have never seen question.

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Got question incorrect. Therefore you are at 20% for trying. Do the question at a later date and get it correct to advance to 40%.

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Got question correct. Therefore, you are at 40%. Now highlight the key tested concept in the explanation and highlight the key clinical findings in the conclusion of the referenced article abstracts to

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Got question correct and read the explanation and conculsion of the abstracts. Therefore, you are at 60%. Answer the question correctly 3 times in a row to advance to 80%.

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Got question correct more than 3 times in a row in the last 60 days. Therefore, you are at 80%. Now type in the correct response and select it from the drop down menu to advance to 100%.

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Have mastered question.

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EVIDENCE

In today's world of medicine, having a firm grasp of the evidence is essential to take good care of patients. Unfortunately, there is a "sea" of evidence, and it can be difficult and time-consuming to choose what is important to read. Orthobullets has done the hard work of filtering for the evidence of which you need to be aware. TARGET CONTENT: Only Orthobullets "Tested" articles count as target content. "Tested Articles" represent a small subset of all the articles and have met specific Orthobullets inclusion criteria. MASTERY TRIGGER: Click on the Selfmastery wheel for EACH "Tested" article to advance based on scale below.

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Presented article at journal club

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TEACHING CASES

Teaching cases are the "cadillac" of learning to apply medical knowledge, the latest evidence, and think critically. They are important because they allow residents to make decisions in an algorithmic pathway - e.g., so you got an MRI in the ER and the patient is alert and oriented, so what is your next step in

management?

TARGET CONTENT: Currently all cases linked to a topic count as target cases. Shortly, target cases will only include specific "core" cases that have been through a specific editorial process and have a certain