A 27-year-old man is involved in a motor vehicle crash and sustains a closed head injury and right intertrochanteric hip fracture with ipsilateral femoral head fracture. He undergoes operative stabilization of his right hip. At 1 year follow-up he has limited rotation and abduction of the hip. Radiographs are shown in Figures A and B. What intervention during his initial treatment could have potentially prevented this outcome?
700 cGy of radiation within 72 hours of surgery
Pulsed administration of recombinant PTH 1,34 postoperatively for 1 year
3 cycles of VAC (Vincristine, Actinomycin D, and Cyclophosphamide)
700 cGy of radiation 2 weeks prior to surgery
3 treatments of 700 cGy of radiation divided over 1 week after surgery
Dr. Anonymous - read the next line of the topic for more information. I've also quoted it below.
although no literature supports, are commonly used"
Spine (Phila Pa 1976). 1994 Feb 01;19(3):309-13.
Thank You for bringing up this paper.My question is: why do You write in the topic:"Heterotopic Ossification" Author: Colin Woon that biphosphonates are used in prophylaxis (citation from the topic: TreatmentProphylaxisbisphosphonates), Please, just look at the text in the topic.and here You write "Oral bisphosphonates are not effective for prophylaxis ".Text in the topic needs correction?
The disease shown in the radiograph and biopsy specimen, Figures A and B, is best characterized by which of the following laboratory findings
Decreased urinary N-telopeptide and increased urinary alpha-C-telopeptide
Low serum vitamin D levels
Increased urinary N-telopeptide and decreased urinary alpha-C-telopeptide
Increased urinary N-telopeptide and alpha-C-telopeptide
Increased urinary N-telopeptide and decreased urinary excretion of pyridinium crosslinks
Just wondering if you were able to address the comments below as the answer is misleading based on the text. - JP
You are seeing a 16-year-old female with shoulder pain. She is otherwise healthy and denies trauma. Based on the radiograph, MRI, and histology shown in Figures A-C, what is your diagnosis?
Simple bone cyst
Aneurysmal bone cyst
Unicameral bone cyst
How on planet earth, from that one X-ray and MRI slice, can it be said that the lesion shown doesn't cross the physis?? It looks like it does on the Xray and on the MRI, it might not. Thank goodness in practice you can look at the other 4 X-rays and 150 MRI slices. But then you could never do that in 1 min 12 seconds - :0)
A 14-year-old boy is brought to the emergency department after falling onto his right shoulder. Radiographs are shown in Figure A. Which of the following is most likely complication to occur with curettage and bone grafting of this lesion?
Metastases to the lungs
Recurrence of the lesion
Limb-length discrepancy of the affected side compared to the contralateral side
Continued pain in the affected extremity
A little bit of semantics at play. LLD is a true compiication, whereas recurrence is just part of the natural process even though Dr Wilkins didn't see it that way!!
A 61-year-old male has a 6 month history of low back pain with increasing left sciatic leg pain for 5 weeks. On examination, he has bone tenderness in the lumbar and thoracic spine. Neurological examination shows 4/5 weakness in the L5 distribution in the left leg. MRI images of the thoracic and lumbar spine are shown in Figures A. Follow-up laboratory studies show anemia associated with the presence of a serum monoclonal protein. What would be the next most appropriate investigation in the diagnostic work-up of this patient?
CT scan of head
Lower extremity electromyelography
Bone marrow aspiration and biopsy
Urine electrophoresis is correct. The question asks 'next most appropriate' - the next most simple and easy thing to do is the urine electrophoresis. Selecting this answer doesn't mean the marrow is not then the next step. Semantics I know but the question needs to be reworded if the answer is not to be changed.
The use of extracorporeally irradiated autografts in pelvic reconstruction following tumour resection
This article is very good update about irradiated autograft in pelvic reconstruction after tumour resection. They suggested 90 Gy with reasonable compications.[PMLINK][PMTITLE]The use of extracorporeally irradiated autografts in pelvic reconstruction following tumour resection.[/PMTITLE] [PMAUTH]Wafa H, Grimer RJ, Jeys L, Abudu AT, Carter SR, Tillman RM[/PMAUTH] [PMSRC]Bone Joint J. 2014 Oct. pii: 96-B/10/1404. doi: 10.1302/0301-620X.96B10.33470. 96-B. (10). :1404-10[/PMSRC] [PMID]25274929[/PMID][/PMLINK]
A 24-year-old male presents with a painful, stiff elbow after sustaining an injury 4 months ago. A radiograph is shown in Figure A. Which of the following statements is true about his condition?
Early excision has been found to decrease rate of recurrence compared to excision after maturity
Radiographs may be used to assess maturity of the lesion
Bone scan will always be negative once the lesion is considered mature
The lesion is considered mature 12 months after initial radiographic findings are seen
Alkaline phosphatase level measurements are used to determine the maturity of the lesion
Seems this question is causing come confusion because in the review of the topic it states that "marked decrease in bone scan activity AND normalization of ALP" are criteria for "timing of resection".
J Spinal Cord Med. 2015 Mar;38(2):193-8. Epub 2014 May 13.
Dr. Anonymous - The explanation to this question is correct. The use of oral bisphosphonates does not appear to significantly decrease heterotopic bone, as discussed above, as well as reported in papers such as the one below:Association between alendronate, serum alkaline phosphatase level, and heterotopic ossification in individuals with spinal cord injury.Ploumis A, Donovan JM, Olurinde MO, Clark DM, Wu JC, Sohn DJ, O'Connor KCJ Spinal Cord Med. 2015 Mar. doi: 10.1179/2045772314Y.0000000213. 38. (2). :193-8PMID: 24820653 (Link to Abstract)
Combined anterior-posterior approach with enlarged sciatic foramen to remove sciatic notch dumbbell-shaped tumors
This is a very good article discussing approach to intrapelvic tumours with extending to gluteal region through greater sciatic foramen[PMLINK][PMTITLE]Combined anterior-posterior approach with enlarged sciatic foramen to remove sciatic notch dumbbell-shaped tumors.[/PMTITLE] [PMAUTH]Li M, Li H, Du Y, Cai Z, Liao H, Guo F, Chen A, Li F, Yang C[/PMAUTH] [PMSRC]J Surg Oncol. 2017 Jan 30. doi: 10.1002/jso.24552[/PMSRC] [PMID]28138989[/PMID][/PMLINK]
in the topic You write-prophilaxis with bisphosphonates, but here, in explanation to chis question You write-bisphosphonates are not effective. Could You explain this?
A 26-year-old man presents with generalized back and joint stiffness and difficulty opening his mouth. His elder sister has similar complaints. Since childhood, he has had 3 surgeries for excision of recurrent bony prominences around his knees. He walks with a stooped over posture seen in Figure A. Radiographs of his feet, knee, hip and spine are seen in Figures B-E respectively. This patient will likely have:
Elevated serum phosphate and serum creatinine
Mutation in ACVR1 gene
HLA B27 antigen
Mutation in EXT gene
This question is inappropriately associated with the MOC 2016 subject of Myositis Ossificans
Histopathology of Bone in Paget's Disease
The histopathology of abnormal bone in Paget's disease is compared with the normal achitecture of trabecular bone in an unaffected specimen.
superb!!! Especially since it gave an overview of normal bone as well.
A 70-year-old man with a history of esophageal cancer presents to the emergency department with pain in his right femur. His right hip xray is shown in Figure A and B. His medical oncologist has estimated he has a life expectancy of less than 6 months. His activities are limited to walking around his house. Which of the following management options is most appropriate?
Sliding hip screw
Proximal femoral locking plate
Proximal femoral replacement
No pre op embolization for renal cell? Is that not the standard? I realize the question doesn't address that specifically but for our education please comment Dr McCulloch.
Witchy is the most common site of metastasis in proximal femur. Isn't the sub trochanteric region most common site of pathological fracture
What is the major side-effect of doxorubicin?
Dr. Howell - this medication is one that is sometimes used when treating orthopaedic primary tumors in a multimodal fashion, and would be important to know if you are treating the patient later in life, as the potential cardiotoxic effect would necessitate an echocardiogram before any future surgeries as part of the preoperative workup.
Why is this question asked to orthopedic surgeons?
A 62-year-old female sustained the injury seen in Figure A after a fall at home. Her past medical history is significant for mild hypertension only. She is not currently taking any medications. Her pre-operative assessment revealed elevated serum alkaline phosphatase. Serum calcium and phosphate were normal. What is the most likely underlying diagnosis?
Paget's bone disease
x-rays are consistent with osteopetrosis and not Paget's disease!