Universidade Federal do Amazonas Hospital Universitário Getúlio Vargas Serviço de Ortopedia e Traumatologia
TARO 2017 – REVISÃO E GABARITO BASEADO NAS REFERÊNCIAS Pesquisado por: Eduardo Rodrigo Nunes Ditzel, Jaime Souza Cruz Menezes, Luis Felipe Tupinambá Da Silva, Luis Fernando Tupinambá Da Silva, Marcelo Lins Gomes, Caio Vanderlei Silveira Capelasso, Carmen Renata Teixeira Mancilha, Jorge Enrique Acosta Noriega, Suammy Da Costa Barros, Tiane Raquel Da Silva Dias, Hildo Alves De Sousa Neto, João Henrique Lima De Oliveira Filho, Marcel Barros Dos Santos, Maryelle Gomes De Oliveira, Shirllane Rodrigues Barros de Azevedo.
Edição e Revisão: José Henrique Peres dos Santos - TEOT - 14847
1. Na fratura do côndilo lateral na criança, o músculo que se mantém preso ao fragmento distal é o A) braquiorradial. B) extensorulnar do carpo. C) extensor comum dos dedos. D) extensor radial longo do carpo. The fracture line usually begins in the posterolateral metaphysis, with a soft-tissue tear in the area between the origins of the extensor carpi radialis longus and the brachioradialis muscle. The extensor carpi radialis longus and brevis muscles remain attached to the distal fragment, along with the lateral collateral ligaments of the elbow. If there is much displacement, both the anterior and posterior aspects of the elbow capsule are usually torn. This soft-tissue injury, however, usually is localized to the lateral side and may help identify a minimally displaced fracture. More extensive soft tissue swelling at the fracture site may indicate more severe soft-tissue injury, which may indicate that the fracture is unstable and prone to late displacement.
FONTE: Rockwood and Wilkins's Fractures in Children 7th Ed. 535 Pg.
2. A estrutura mais importante para garantir a estabilidade do cotovelo no estresse em valgo a 90° de flexão é A) a cabeça do rádio. B) a cápsula articular. C) o ligamento colateral lateral. D) o ligamento colateral medial. A estabilidade em valgo é dividida igualmente entre o ligamento colateral medial, a cápsula anterior e a articul ação óssea com o cotovelo em extensão completa. Em 90 graus de flexão, o ligamento colateral medial proporciona 55% da estabilidade ao estresse em valgo, com o feixe anterior sendo o estabilizador primário.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2296Pg.
3. Na gonartrose unicompartimental medial, preconiza-se para o paciente de 50 anos de idade com joelho varo de 25° A) artroplastia total do joelho. B) osteotomia tibial de adição medial. C) artroplastia unicompartimental medial. D) osteotomia femoral de cunha de subtração lateral. The indications for proximal tibial osteotomy are (1) pain and disability resulting from osteoarthritis that significantly interfere with high-demand employment or recreation and (2) evidence on weight-bearing radiographs of degenerative arthritis that is confined to one compartment with compartment with a corresponding varus or valgus deformity. Contraindications to a proximal tibial osteotomy are (1) narrowing of lateral compartment cartilage space, (2) lateral tibi al subluxation of more than 1 cm, (3) medial compartment tibial bone loss of more than 2 or 3 mm, (4) flexion contracture of more than 15 degrees, (5) knee flexion of less than 90 degrees, (6) more than 20 degrees of correction needed, (7) inflammatory ar thritis, and (8) significant peripheral vascular disease. Coventry recommended a medial closing wedge osteotomy to correct valgus deformity; however, if however, if the valgus deformity is larger than 12 degrees, or if the joint surface tilt of the tibia after osteotomy will be more than 10 degrees, he recommended a supracondylar medial closing wedge femoral osteotomy instead.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 471Pg.
4. A fratura toracolombar por explosão é caracterizada por A) deslocamento de uma vértebra sobre outra. B) aumento da distância dos processos espinhosos . C) aumento da distância interpedicular da vértebra fraturada. D) presença de mais de cinco fragmentos da vértebra fraturada . As principais características desta lesão são fraturas do corpo vertebral na região posterior com retropulsão de osso em direção ao canal vertebral e ampliação da distância interpedicular relativa aos níveis adjacentes.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2296Pg. 5. Na escoliose idiopática do adolescente, uma paciente de 14 anos com menarca há dois anos e ângulo de COBB de 35° deve A) receber alta ortopédica. B) ser observada com radiografias seriadas. C) receber prescrição de colete de MILWAUKEE por dois anos. D) ser operada com artrodese das vértebras envolvidas na curvatura. Curves of 30 to 40 degrees in skeletally mature patients generally do not require treatment, but because studies indicate a potential for progression in adult a dult life, these patients should be observed with yearly standing posteroanterior radiographs for 2 to 3 years after skeletal maturity and then every 5 years throughout life.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 1715 Pg.
6. Na deficiência femoral focal proximal, a anomalia congênita mais comumente associada é A) coxa vara. B) hemimelia fibular. C) pé torto congênito. D) pseudartrose congênita da tíbia. Fibular deficiency is the most common cause of long bone congenital limb deficiency, when considering that fibular deficiency often accompanies femoral deficiency. Femoral deficiencies arc the next-most common, with an incidence between 1 in 50,000 and 1 in 200,000 live births. Femoral deficiencies include the spectrum of the congenital short femur with a stable hip joint and a knee without significant contracture to proximal femoral focal deficiency (PFFD). The prevalence of tibial deficiencies is far less than either fibular or femoral deficiencies and is reponed to be approximated one per million live births.
FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 1350 Pg.
7. Na pseudartrose congênita da tíbia, a deformidade angular característica é A) anterolateral. B) anteromedial. C) posterolateral. D) posteromedial. Congenital Pseudarthrosis of the Tibia Definition. Bowing of the tibia that presents at birth typically is either anterior, anterolateral, or posterior medial Anterior tibial
bowing that occurs in association with a deficient or absent fibula is diagnostic of fibular hemimelia. Posterior medial bowing occurs in association with calcaneovalgus foot deformity and has a good prognosis. In oontr: ast, anterolateral bowing. which usually presents soon after birth, is typically a progressive deformity which often results in a psedoarthrosis. Anterolateral bowing associated with congenital pseudarthrosis of the tibia (CP1) is rare (1:140,000), ytt it is the most common type of congenital pseudarthrosis . Neurofibromatosis occurs in more than 50% of patients with anterolateral bowing, with or without pseudarthrosis of the tibia. This bowing may be the first clinical manifestation of neurofibromatosis.
FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 1189 Pg. 8. O principal estabilizador estático da articulação glenoumeral é o ligamento A) coracoumeral. B) glenoumeral médio. C) glenoumeral inferior. D) glenoumeral superior.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 11th ED. 2213Pg.
9. Para a prevenção da síndrome da dor regional complexa após fratura do terço distal do rádio, indica-se a administração diária de vitamina A) A. B) C. C) D. D) E. FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 1 3th ED. 2213Pg.
10. Na luxação congênita da cabeça do rádio, os desvios mais comuns são A) anterior e anterolateral. B) anterior e anteromedial. C) posterior e posterolateral. D) posterior e posteromedial. Congenital radial head dislocation may be bilateral or unilateral (162). It is defined by the din:ction of subluxation or dislocation. Most congenital dislocations are posterior or posterolateral. It is important to distinguish the congenital dislocation from the posttraumatic dislocation. Because the condition frequency presents late, this distinction can be confusing (162, 157). This is especially true for willateral anterior dislocations in otherwise healthy children (163-166). Radiographic criteria have been established to distinguish this lesion from a chronic, traumatic dislocation. These include a small, dome shaped radial head; a hypoplastic capitellum; ulnar bowing with volar convexity in the anterior dislocation and dorsal convaity in the posterior dislocation; and a longitudinal axis of the radius that does not bisect the capitellum.
FONTE (official) : Lovell and Winter's Pediatric Orthopaedics 6th Ed 934 Pg. FONTE(encontrada): Lovell and Winter's Pediatric Orthopaedics 6th Ed 923 Pg.
11. A fratura “em galho verde” do olécrano associada à fratura do colo do rádio ocorre quando o antebraço e o cotovelo estão,
respectivamente, em A) pronação e varo. B) supinação e varo. C) pronação e valgo. D) supinação e valgo. A Monteggia type III fracture pattern is created when a varus force is applied across the extended elbow , resulting in a greenstick fracture of the olecranon or proximal ulna and a lateral dislocation of the radial head. 124 Occasionally, however, the failure occurs at the radial neck (Monteggia III equivalent) and the radial neck displaces laterally, leaving the radial head and proximal neck fragment in anatomic position under the annular ligament (Fig. 13-11). 70 Rotational forces may fracture the radial neck in young children before ossification of the proximal radial epiphysis. This has been described only in case reports with a supination force. 33,40 Reduction was achieved by pronation of the forearm. Diagnosis of these injuries is difficult and may require arthrography or an examination under general anesthesia. This injury should be differentiated from the more common subluxation of the radial head (“nursemaids elbow”), in which the forearm usually is held in pronation with resistance to supination
FONTE (official): Rockwood and Wilkins's Fractures in Children 7th Ed. 435 Pg. FONTE(encontrado): Rockwood and Wilkins's Fractures in Children 8th Ed. 481 Pg
12. No pé talo vertical, há contratura A) do tibial anterior. B) da fáscia plantar. C) do tibial posterior. D) do flexor longo do hálux. Pathoanatomy. Autopsy and surgical findings have confirmed consistent pathoanatomic findings in congenital vertical talus (280 -
283). Most have found contractures of the tibialis anterior, extensor hallucis longus, extensor hallucis brevis, peroneus tertius, peroneus longus, peroneus brevis, and the Achilles tendon. The peroneus longus and peroneus brevis may be anteriorly subluxed over the lateral malleolus, and the posterior tibial tendon may be subluxed anteriorly over the medial malleolus. The severe plantar flexion of the talus results in contact of only the most posterior aspect of the talar dome with the distal tibial articular cartilage. There is dorsal extension of the articular cartilage of the talar head to accommodate the proximal articular contact with the navicular, which is wedge shaped with a hypoplastic plantar segment. The head of the talus generally protrudes below the posterior tibial tendon, and the calcaneonavicular, or spring ligament, is markedly attenuated. The calcaneus is severely externally rotated and everted, with its posterolateral border in proximity to the fibula. The sustentaculum tali and anterior facet of the subtalar joint are exceedingly hypoplastic or absent in the most severe cases. The dorsal capsule of the talonavicular joint is thickened and contracted.
FONTE (oficial) : Lovell and Winter's Pediatric Orthopaedics 6th Ed 1289 Pg. FONTE (encontrado) : Lovell and Winter's Pediatric Orthopaedics 6th Ed 1460 Pg.
13. Na síndrome do nervo interósseo anterior, há fraqueza ou paralisia do A) pronador redondo. B) flexor radial do carpo. C) flexor longo do polegar. D) flexor superficial do indicador. According to Spinner, the anterior interosseous syndrome can cause various signs and symptoms. Typically, the patient has pain in the proximal forearm lasting for several hours and is found to have weakness or paralysis of the flexor pollicis longus, the flexor digitorum profundus to the index and long fingers, and the pronator quadratu s. When the patient attempts to pinch, active flexion of the distal phalanx of the index finger is impossible. Variations from these signs and symptoms usually result from atypical patterns of innervation. If all of the flexor digitorum profundus muscles are supplied by the anterior interosseous nerve, all of these muscles are weak or paralyzed. Conversely, if innervation overlaps, and the ulnar nerve supplies the flexor digitorum profundus to the long finger, this finger is spared. EMG, the Ninhydrin print test, and clinical examination help to differentiate the syndromes. In well-established lesions, atrophy of the forearm flexor mass and of the thenar muscles may be seen.
FONTE(official): Canale & Beaty: Campbell's Operative Orthopaedics 13th ED. 3111Pg. FONTE(encontrado): Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 3111Pg ________________________________________________________________________________________________________ 14. Na fratura diafisária da clavícula, os desvios típicos do fragmento lateral são A) translação inferior e rotação posterior. B) translação superior e rotação posterior. C) translação inferior e rotação anterior. D) translação superior e rotação anterior. The clavicle is not as important as the scapula in terms of muscle origin, but still serves as the attachment site of several large muscles. Medially, the pectoralis major muscle originates from the clavicular shaft anteroinferiorly, and the sternocleidomastoid originates superiorly. The pectoralis origin merges with the origin of the anterior deltoid laterally, while the trapezius insertion blends superiorly with the deltoid origin at the lateral margin (Fig. 38-18). Muscle attachment plays a significant role in the deformity which results after fracture: The medial clavicular fragment is elevated by the unopposed pull of the sternocleidomastoid muscle, while the distal fragment is held inferiorly by the deltoid and medially by the pectoralis major. The undersurface of the clavicle is the insertion site of the subclavius muscle, which is of little significance functionally but serves as a soft tissue buffer in the subclavicular space superior to the brachial plexus and subclavian vessels. The platysma or “shavin g muscle” is variable in terms of thickness and extent, but usually envelopes the anterior and superior aspects of the clavicle and runs in the subcutaneous tissues, extending superiorly to the mandible and the deeper facial muscles. It is divided during the surgical approach, and is typically included in the closure of the superficial, or skin/subcutaneous layer. FONTE: Rockwood and Wilkins's Fractures in Adult 7th Ed. 1108 Pg. FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 1441 Pg.
15. A sinostose radioulnar ocorre com maior frequência nas fraturas do rádio e da ulna localizadas no terço A) distal e operadas por incisão dupla. B) distal e operadas por incisão única. C) proximal e operadas por incisão única. D) proximal e operadas por incisão dupla.
FONTE: Rockwood and Wilkins's Fractures in Adult 7th Ed. 535 902 Pg.
16. No paciente com mielomeningocele e escoliose, a rápida progressão da curva vertebral associa –se a A) hidrocefalia e meningite. B) medula ancorada e hidrocefalia. C) meningite e contratura em flexão dos quadris. D) contratura em flexão dos quadris e medula ancorada. Scoliosis typically develops gradually in patients < 1 0 years of age and then increases rapidly with the adolescent growth spurt. When a curve develops in a child younger than 6 years of age, it may be related to an underlying hydromyelia or a tethered cord syndrome. Muller et al. (61) found that curve progression was related to size of the curve with curves <20 degrees progressing slowly. In contrast, curves >40 degree progressed severely and quickly at almost 13 degrees per year.
FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 618Pg.
17. Na ruptura da porção distal do bíceps braquial, o diagnóstico pelo “teste do gancho” é feito com a tentat iva de palpar o tendão
em sua face A) lateral, com flexão ativa do cotovelo. B) medial, com flexão ativa do cotovelo. C) lateral, com flexão passiva do cotovelo. D) medial, com flexão passiva do cotovelo. The hook test can be used for the diagnosis of complete biceps tendon avulsions: with the elbow actively flexed and supinated, the examiner should be able to “hook” an index finger under a cordlike structure in the antecubital fossa if the t endon is intact. This test was reported to have 100% sensitivity and specificity; however, the examiner must be sure to hook the lateral edge of the biceps tendon, not the medial edge, because the lacertus fibrosus might be mistaken for an intact biceps tendon.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2349Pg. 18. O índice de gravidade da instabilidade glenoumeral (ISIS) inclui A) gênero e idade no ato da cirurgia. B) gênero e idade no primeiro episódio. C) esporte de contato e idade no ato da cirurgia. D) esporte de contato e idade no primeiro episódio.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2281Pg. 19. Na fratura diafisária do úmero tratada com redução aberta e fixação interna rígida pela via anterolateral, a complicação mais frequente é A) infecção. B) refratura. C) não união da fratura. D) paralisia do nervo radial.
COMPLICATIONS The most frequently reported complication after plate fixation of humeral shaft fractures is radial nerve palsy. When using an anterolateral (brachialis-splitting) approach, it is essential to ensure that the nerve is not under the implant during plate application to avoid iatrogenic radial nerve injury.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2855-56Pg. 20. Na doença de DUPUYTREN, os nódulos de GARROD localizam-se na face A) volar da articulação MF. B) volar da articulação IFP. C) dorsal da articulação MF. D) dorsal da articulação IFP.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 3696Pg. FONTE (encontrada): Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 3626Pg. 21. Na fratura consolidada da diáfise da tíbia tratada com haste intramedular, a queixa mais comum é a dor no local da A) inserção da haste. B) extremidade distal da haste. C) inserção de parafusos de bloqueio distal. D) inserção de parafusos de bloqueio proximal.
Knee Pain . Pain that persists at the IM nail insertion site after fracture healing is not unusual, especially if any hardware is prominent or the nail was inserted through the patellar ligament.“ Skeletal Trauma, Jupiter.
CHAPTER 57. Tibial Shaft Fractures, page 2181. FONTE Oficial :Jupiter J:. Skeletal Trauma 4th Ed. 2373 Pg. 22. Na fratura da extremidade distal do fêmur, a complicação mais comum é A) a pseudartrose. B) a perda de movimento do joelho. C) o encurtamento maior que 5 mm. D) a deformidade angular maior que 5 graus.
FONTE: Rockwood and Wilkins's Fractures in Adult 7th Ed. 3430-31 Pg. 23. Na ruptura do ligamento cruzado anterior do joelho, a fratura de SEGOND corresponde à avulsão da A) margem lateral da tíbia. B) margem medial da tíbia. C) eminência intercondilar. D) ápice da cabeça da fíbula. Também ocorrem frequentemente lesões intra-articulares de tecido mole, tanto aos ligamentos cruzados como aos meniscos.1·168·172 Essas lesões desempenham certo papel no tratamento das fraturas do platô tibial e serão discutidas mais detalhadamente na seção Tratamento de lesões de tecido mole associadas a fraturas do platô tibial. Certas fraturas periféricas das bordas do platô tibial são virtualmente patognomônicas de lesão a ligamento cruzado e, nesses joelhos lesionados, será apropriado enfatizar o tratamento das lesões ligamentares, em vez da própria fratura do platô. Essas fraturas são a fratura de Segond, a fratura de Segond invertida, fraturas da borda tibial anteromedial e fraturas no local de inserção do tendão do semimembranoso.34,40,13s.147 FONTE: Rockwood and Wilkins's Fractures in Adult 7th Ed. 4672-73 Pg. 24. Na fratura-luxação de MONTEGGIA no adulto, os piores resultados são esperados para as lesões, segundo BADO, do tipo A) 1. B) 2. C) 3. D) 4. Ring and Jupiter reported 83% good and excellent results with open reduction a nd stable fixation. Poor results are most frequent in Bado type 2 fractures, which are more complex injuries with elbow dislocations and fractures of the coronoid and radial head and greater soft tissue compromise
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2886Pg 25. O trauma do antebraço da criança causado por mecanismo de hiperpronação associa-se à fratura A) transversa isolada do rádio. B) do rádio e da ulna no mesmo nível. C) do rádio e da ulna em níveis diferentes. D) do rádio com luxação radiulnar proximal.
FONTE: Rockwood and Wilkins's Fractures in Children 7th Ed. 350 Pg. 26. No menisco discoide, segundo a classificação de WATANABE, o tipo que mais comumente se apresenta com ressalto lateral (snapping) em uma criança de 2 a 3 anos é o A) I. B) II. C) III. D) IV. Clinical Features The clinical presentation of a child with this condition depends on the type of discoid meniscus. The discoid meniscus with deficient peripheral attachments (Type III) presents in a young child of 2 to 3 years of age as a “snapping knee syndrome.” As the knee is brought from flexion into full extension, a painless, palpable, and au dible snap occurs. The child may also have painless giving way resulting in unexplained falls. Type I and Type II discoid menisci do not usually present until the child or adolescent actually tears the discoid meniscus, which is prone to happen due to its large surface area. These patients have joint-line pain and tenderness, and have an effusion. Catching, locking, and giving way are also suggestive of tears in a discoid meniscus if the location is lateral. This typically occurs in the middle of the child's 2nd decade of life as the child approaches skeletal maturity, or in early adulthood. In other respects Type I and Type II discoid menisci are asymptomatic.
Watanabe type I
Watanabe type II
FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 4497 Pg. 27. A lesão dos isquiotibiais ocorre mais frequentemente A) no tendão. B) no ventre muscular. C) na junção miotendinea. D) por avulsão da tuberosidade isquiática.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2345Pg. 28. Na fratura-luxação da base do primeiro metacarpo, o desvio em supinação do segmento distal ocorre pela ação do músculo A) adutor do polegar. B) oponente do polegar. C) abdutor curto do polegar. D) extensor curto do polegar.
FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 973 Pg.
29. Na síndrome do túnel do carpo, a circulação epineural é prejudicada quando a pressão intratúnel se dá a partir de A) 5 mm Hg. B) 10 mm Hg. C) 15 mm Hg. D) 20 mm Hg.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 13th ED. 3750Pg.
Watanabe type III
30. No teste de FROMENT, os músculos do polegar avaliados são A) adutor e flexor curto. B) adutor e abdutor curto. C) oponente e flexor curto. D) oponente e abdutor curto. Solicitamos ao paciente que apoie o dorso da mão na mesa de exame e avaliamos o movimento ativo do polegar. Pegamos uma folha de papel e pedimos ao paciente que a segure na outra extremidade, com a mão que estamos examinando. O paciente prenderá a folha entre a polpa do polegar e o lado radial do dedo indicador (pinça da chave). Na sequência, pedimos que segure f irme e lentamente vamos puxando o papel. Quando houver paralisia do nervo ulnar, o paciente fletirá a articulação interfalângica do polegar e usará o músculo flexor longo do polegar como um substituto funcional dos músculos adutor do polegar e f lexor curto do polegar, que se encontram sem função. Esse é o teste de Froment
FONTE: Leite NM, Faloppa F. Propedeutica Ortopédica e Traumatologia 2013 Ed. 135.PG
31. Na imobilização da mão em posicionamento funcional, as metacarpofalângicas devem ficar em flexão de A) 30º. B) 45º. C) 60º. D) 90º. Burkhalter Cast. This cast is u sed to treat metacarpal or phalangeal fractures. The wrist is placed in 40 degrees of extension and the metacarpophalangeal joints are placed in 70 to 90 degrees of flexion (Fig. 6-18). The cast relies on the intact dorsal hood of the fingers acting as a tension band or a soft tissue hinge. It is usually applied by placing a slab over the dorsum of the forearm and the hand, with the wrist and fingers in the correct position and then applying a forearm cast to secure the slab. Finger extension is not permitted by the dorsal slab but some flexion is allowed. James Cast. In this cast the fingers are kept in the ‘‘position of function’’ of the hand. The wrist is maintained at 40 degrees of extension with the metacarpophalangeal joints at 90 degrees and the interphalangeal joints of the fingers at 70 to 90 degrees. In this position the collateral ligaments of the metacarpophalangeal joints and the interphalangeal joints are stretched maximally and thus contractures will not occur (Fig. 6-19). As with the Burkhalter cast, the James cast is in fact a combination of a slab and a cast. Initially a volar slab is applied to the forearm and hand with the joints in the correct position. A forearm cast is then applied.
FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 170 Pg.
32. Na classificação anatômica de JEFFERSON, a deformidade de COCK-ROBIN é encontrada na fratura multifragmentar A) do arco anterior. B) da massa lateral. C) do arco posterior. D) do processo transverso.
Lateral mass fractures are generally the result of combined axial loading and lateral compression. If severe enough, the occipital condyle can settle onto the lateral mass of C2, creating a cock-robin deformity. Unilateral lateral mass sagittal split fractures have been described by Bransford to occur and led to late cockrobin deformity, significant loss of neck rotation, and severe neck pain that required traction and occipitocervical fusion, even in the face of an intact transverse atlantal ligament. 65 FONTE: Jupiter J:. Skeletal Trauma 4th Ed. 782 Pg.
33. Na coxa vara do desenvolvimento, os movimentos mais limitados são A) adução e rotação lateral. B) adução e rotação medial. C) abdução e rotação lateral. D) abdução e rotação medial. The range of motion of the hip is reduced in all planes of motion, with limitations of abduction and internal rotation being the greatest (12, 25). The limitation in abduction is due to impingement of the greater trochanter on the side of the pelvis. The loss of internal rotation is due to the loss of the femoral neck anteversion that is a feature of developmental coxa vara. As part of the general clinical examination, other causes of coxa vara should be ruled out, for example, skeletal dysplasias (15, 31). FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 1223 Pg.
34. A fusão da cartilagem trirradiada ocorre aproximadamente entre as idades de A) 9 a 11 anos. B) 12 a 14 anos. C) 15 a 17 anos. D) 18 a 20 anos.
Pelvic and Acetabular Development The pelvis of a child arises from three primary ossification centers: The ilium, ischium, and pubis. The three centers meet at the triradiate cartilage and fuse at approximately 12 to 14 years of age (Fig. 25-7).59
FONTE: Rockwood and Wilkins's Fractures in Children 8th Ed. 929Pg.
35. O nervo ulnar, no túnel cubital, passa sob A) o ligamento transverso. B) a fáscia de OSBORNE. C) a fáscia de STRUTHERS. D) o ligamento colateral ulnar. FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 1893 Pg.
36. No osteossarcoma, é sinal de mau prognóstico a elevação da A) interleucina 6. B) proteína C reativa. C) desidrogenase láctica. D) velocidade de hemossedimentação. The remainder of the physical examination is normal, except in the rare (<1%) patient who presents with bone metastases or multiple focal osteosarcoma. One-half of all patients have elevated serum alkaline phosphatase (extremely high serum alkaline phosphatase values indicate a worse prognosis), and approximately one-fourth of all patients have elevated serum LDH level (an elevated LDH level also is associated with a worse prognosis). The rest of the laboratory values for blood and urine are normal. FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 464 Pg. 37. Na distrofia muscular de DUCHENNE, a fraqueza do quadríceps e do glúteo máximo é evidenciada pelo sinal de A) OBER. B) JACOB.
C) GOWER. D) MEYERON. Clinical diagnosis of Duchene muscular dystrophy is established by physical examination, including gait and specific muscle weakness, and by the absence of sensory deficits. The upper extremity and knee deep-tendom reflexes are lost early in the disease, whereas the ankle reflexes remain positive until the terminal phase. A valuable clinical sign is the Gower Sign. The patient is placed prone or in the sitting position on the floor and asked to rise. This is usually difficult, and the patient may require the use of a chair for assistance. The patient is then asked to use his or her hands to grasp the lower legs and force the knees into extension. The patients then walks his or her hands up the lower extremity to compensate for the weakness in the quadriceps and gluteus maximum.
FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 591 Pg.
38. Os tecidos ósseo e conjuntivo são formados pela placa A) lateral do ectoderma. B) medial do ectoderma. C) lateral do mesoderma. D) medial do mesoderma. The bones and connective tissues of the limbs are formed by lateral plate mesoderm , and the muscles originate from myotome regions of the somitic mesoderm.
FONTE: Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 951 PG
39. As porcentagens médias do crescimento fisário proximal e distal do úmero são, respectivamente, de A) 60% e 40%. B) 70% e 30%. C) 80% e 20%. D) 90% e 10%. FONTE: Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 19 PG
40. Na lesão do nervo axilar, ocorre hipoestesia no braço nas faces A) lateral e inferior. B) medial e inferior. C) lateral e superior. D) medial e superior. Neurovascular injury is unusual but has to be excluded by careful cli nical examination. Axillary nerve sensation should be examined as this is the most frequently affected nerve. Hypoesthesia over the lateral aspect of the proximal arm suggests an axillary nerve injury. Theoretically motor function of the axillary nerve can be assessed by palpating the deltoid as the patient attempts to actively extend, abduct, and flex the shoulder but pain often precludes this. FONTE: Rockwood and Green’s Fractures in adults, 8th Ed, Pg 1346. 41. O percentual de rerruptura do tendão calcâneo em atletas, após o tratamento cirúrgico é A) menor que 5%. B) de 5% a 10%. C) de 10% a 15%. D) maior que15%. ...e outros, recomendaram o reparo cirúrgico em indivíduos atléticos por causa da baixa porcentagem de ocorrência de nova ruptura (2% a 3% versus 10% a 30% com o tratamento conservador).
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 11th ED. 2459Pg.
42. Na osteomielite hematogênica aguda, a região metafisária é mais acometida por apresentar pequeno número de A) linfócitos. B) macrófagos. C) osteoblastos. D) osteoclastos. Methapyseal bone adjacent to the Physis is the most common site for AHO to develop. Hobo (32) described vascular loops presents in the long bone methaphysis that take sharp bends and empty into venous lakes, creating areas of turbulence where bacteria accumulate and cause infection. Relative absence of tissue macrophages in methapyseal bone adjacent to the physis appears to contribute to the predilection of osteomyelitis for this location.
FONTE: Lovell and Winter’s Pediatric Orthopaedics, 7th edition, pg. 371
43. As fraturas do polo proximal do escafoide em crianças ocorrem por avulsão do ligamento A) radiocapitato. B) escafocapitato. C) radiossemilunar. D) escafossemilunar. A proximal pole fracture may propagate through the interface between newly ossified tissue and the cartilaginous anlage, or the injury may be strictly through the cartilage. Proximal fractures may cause destabilization of the scapholunate joint, as the scapholunate interosseous ligament remains attached to the avulsed fragment
FONTE: Rockwood and Wilkins's Fractures in Children 8th Ed. 452 Pg.
44. No alongamento dos membros utilizando fixador externo, os tecidos que apresentam melhor capacidade de metaplasia e diferenciação estão na seguinte ordem: A) ósseo, muscular, ligamentar e tendíneo. B) ósseo, muscular, tendíneo e ligamentar. C) muscular, ósseo, ligamentar e tendíneo. D) muscular, ósseo, tendíneo e ligamentar. As noted by Ilizarov, all tissues will respond to a slow application of prolonged tension with metaplasia and the differentiation into the corresponding tissue type. Bone responds best followed by muscle, ligament, and tendons in that order. Neurovascular structures will respond with gradual new vessels and some degree of nerve and vessel lengthening. However, they respond very slowly and are intolerant of acute distraction forces
FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 259 Pg.
45. Nas lesões da fibrocartilagem triangular, a perfuração central corresponde à classificação de PALMER do tipo A) 1A. B) 1B. C) 1C. D) 1D.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 13th ED. 3526Pg. 46. No trauma raquimedular com choque neurogênico, são observadas as seguintes alterações clínicas A) bradicardia, débito urinário baixo e extremidades frias. B) taquicardia, débito urinário baixo e extremidades frias. C) bradicardia, débito urinário normal e extremidades quentes. D) taquicardia, débito urinário normal e extremidades quentes.
FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 1655 Pg. 47. Na SCIWORA, o mecanismo de trauma mais comum é A) flexão e rotação. B) flexão e distração. C) compressão e rotação. D) compressão e distração. A lap belt used for a child can create a point of rotation about which the spine is flexed with an abrupt stop. This is a common mechanism for creating both intra-abdominal and flexion – distraction spinal injuries. This scenario has been termed SCIWORA, a phenomenon much more common in children than adults. It is thought that the flexibility of the immature spine allows spinal column segmental displacements great enough to lead to SCI without mechanically disrupting the bony and/or ligamentous elements.57 Although these injuries may not be visible on plain radiographs, nearly all will have some evidence of soft tissue injury of the spine on more sensitive magnetic resonance imaging (MRI) studies.29 The term SCIWORA is less relevant in the era of routine MRI, which is now obtained in all patients with possible SCI39 and some have suggested a new acronym SCIWONA (SCI without neuroimaging abnormality).
FONTE: Rockwood and Wilkins's Fractures in Children 8th Ed. 1159 Pg 48. A hérnia discal que compromete a função do músculo bíceps braquial localiza-se no nível A) C3-C4 ou C4-C5. B) C4-C5 ou C5-C6. C) C5-C6 ou C6-C7. D) C6-C7 ou C7-T1.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2296Pg.
49. A infecção por tuberculose na coluna vertebral localiza-se mais frequentemente no A) arco vertebral. B) disco intervertebral. C) terço médio do corpo vertebral. D) terço anterior do corpo vertebral.
Skeletal tuberculosis most often affects the spine (308), usually in the anterior third of a vertebral body in the lower thoracic or the upper lumbar spine. The first lumbar vertebra is most commonly involved, whereas T1 0 infection is most commo nly associated with neurologic deficit (309). Paravertebral abscess formation is characteristic, and calcification developing within the abscess is almost diagnostic of a tuberculous abscess. The discs become involved when two adjacent vertebral bodies are affected. The bone lesions in the vertebral bodies are mainly destructive. This frequently leads to kyphotic deformity, which becomes rigid when chronic. Patients with significant kyphosis often present with neurologic deficit (310).
FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 409 Pg 50. A fratura por estresse com desvio superior a 2mm, segundo KAEDING-MILLER, é classificada como grau A) I. B) II. C) III. D) IV.
FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 656 Pg. 51. A doença de PAGET na forma poliostótica, o percentual de degeneração sarcomatosa é A) menor que 1%. B) entre 1% e 5%. C) entre 5% e 10%. D) maior que 10%. Secondary osteosarcomas occur at the site of another disease process. They rarely occur in young patients but constitute almost half of the osteosarcomas in patients older than age 50 y ears. The most common factors associated with secondary osteosarcomas include Paget disease and previous radiation therapy. The incidence of osteosarcoma in Paget disease is approximately 1% and may be higher (5% to 10%) for patients with advanced polyostotic disease. FONTE (Oficial): Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 913 Pg. FONTE (resposta encontrada): Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 912 Pg.
52. A fratura por estresse da base do quinto metatarsiano ocorre na zona A) I. B) II. C) III. D) IV. Zone I is the most proximal zone and includes the metatarsocuboid articulation, but it is proximal to the fourth and fifth metatarsal articulation. Fractures in this area are avulsion types of injuries, usually secondary to an inversion injury to the foot. Zone II extends from zone I to the metaphyseal/ diaphyseal junction and includes the fourth and fifth metatarsal articulation. This is the area of the true Jones fracture. The mechanism of injury is usually that of a strong abduction force to the forefoot, causing a bending moment at the metaphyseal-diaphyseal junction. Zone III is the proximal 1.5 cm of the diaphysis and is the area where stress fractures usually occur.
FONTE (official): Canale & Beaty: Campbell's Operative Orthopaedics 13th ED. 4330Pg. FONTE (resposta encontrada): Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 4197Pg.
53. A fratura de TILLAUX no tornozelo de uma criança pode ser classificada como A) SALTER-HARRIS I ou II. B) SALTER-HARRIS II ou III. C) SALTER-HARRIS III ou IV. D) SALTER-HARRIS I ou IV. FRATURAS DE TILLAUX
Uma fratura especial que ocorre em adolescentes mais velhos originalmente foi descrita por Tillaux. O mecanismo de lesão é uma força em rotação externa com estresse colocada no ligamento tibiofibular anterior, causando avulsão da li.se distal da tíbia anterolateralmente (Fig. 36-198). Isso ocorre após a parte medial da li.se ter se fechado (Fig. 36-199), mas antes da parte lateral se fechar. A fratura resultante através da fise atravessa a epífise e distalmente a articulação, criando uma fratura de Salter-Harris do tipo III ou IV.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 13th ED. 1550Pg. 54. A artrite reumatoide provoca no retropé uma deformidade em A) varo. B) valgo. C) equino. D) calcâneo. O retropé e o tornozelo estão envolvidos em 30% a 60% dos pacientes com artrite reumatoide. Deformidades no retropé muitas vezes são o aspecto mais limitante para a deambulação. Os problemas clínicos mais importantes do retropé reumatoide são calcanhar em valgo com colapso do arco plantar medial e rotação em um plano axial do antepé. Estes problemas podem ser causados por sinovite, hipertrofia sinovial, ou destruição articular da articulação tibiotalar (tornozelo), subtalar e talonavicular.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 4174Pg. 55. No pé cavo, o antepé está, em relação ao retropé, A) pronado. B) varizado. C) supinado. D) valgizado. The forefoot becomes rigidly pronated in relation to the hindfoot. The tripod effect (48) accounts for the varus position that the hindfoot must assume during weight bearing due to the fixed pronation of the forefoot. Also contributing to the varus deformity of the hindfoot is the muscle imbalance between the tibialis posterior, an invertor of the subtalar joint, that remains strong and the peroneus brevis, an evenor of the subtalar joint, that becomes weak (47). The subtalar joint eventually becomes rigidly deformed in varus because of contracture of the plantar-medial soft tissues, including those of the subtalar joint complex. Although the triceps surae does not become contracted in CMf, it does in some of the other diseases that cause cavus.
FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 1395-96 Pg. 56. No tratamento da osteoporose, o uso dos bifosfonados A) inibe a ação dos osteoclastos. B) inibe a ação dos osteoblastos. C) estimula a ação dos osteoclastos. D) estimula a ação dos osteoblastos. Bisphosphonates are synthetic pyrophosphate analogues which build into the hydroxyapatite of the skeleton similarly to calcium. Bisphosphonates are the predominant first-choice drugs for specific treatment of osteoporosis both in women and men. Bisphosphonates act through preventing the osteclasts from resorbing bone. Alendronate and risedronate are the agents most studied [68 –70]. They have significant positive effect on BMD in post-menopausal women, especially after a previous vertebral fracture. FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 290 Pg. 57. As mucopolissacaridoses mais frequentes são as síndromes de A) HURLER e MORQUIO. B) MORQUIO e HUNTER. C) HUNTER e SANFILIPPO A.
D) SANFILIPPO A e HURLER. All the MPS are autosomal recessive except for mucopolysaccharidosis type II (Hunter syndrome), which is X-linked. The most common MPS are type I (Hurler syndrome) and type IV (Morquio syndrome).
FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 255 Pg. 58. O fibroma não ossificante é uma lesão que se situa A) excentricamente na diáfise. B) concentricamente na diáfise. C) excentricamente na metáfise. D) concentricamente na metáfise. A NOF is a metaphyseal lesion eccentrically located (Fig. 13-20). This lesion grows into the medullary canal. It is surrounded by a well-defined, sharp rim of sclerotic reactive bone. There should be no acute periosteal reaction unless there has been a fra cture. There may be slighdy increased uptake on the technetium99 bone scan. Multiple NOFs occur in approximately 20% of the patients. FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 448 Pg. 59. A deformidade de MADELUNG é mais frequente no sexo A) feminino e bilateral. B) feminino e unilateral. C) masculino e bilateral. D) masculino e unilateral. Support for a systemic cause acting locally is provided by the fact that the condition is twice as likely to be bilateral as unilateral and four times more common in girls than in boys.7 FONTE: Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 408 PG
60. O cisto ósseo aneurismático na coluna vertebral ocorre com maior frequência na parte A) anterior do corpo vertebral e acima de 20 anos. B) posterior do corpo vertebral e acima de 20 anos. C) anterior do corpo vertebral abaixo de 20 anos. D) posterior do corpo vertebral abaixo de 20 anos. Aneurysmal bone cyst (ABC) is rare (incidence approximately 3.2 per million) benign lesion of bone composed of blood filled spaces separated by connective tissue septa [46]. Histologically these septa are more or less rich in fibroblasts, osteoclast-like giant cells and newly formed reactive woven bony trabecules. ABC is most common during the first two decades of life (Table 1) and affect mostly the metaphysis of long bones (femur, tibia and humerus), the pelvis and the posterior elements of vertebral bodies.
FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 1893 61. No osteocondroma, a origem é A) da cartilagem hialina. B) uma má formação óssea. C) de pequenos nódulos cartilaginosos. D) uma alteração do crescimento ósseo. Os condromas são lesões benignas fo rmadas por cartilagem hialina. Eles são comuns e todas as faixas etárias são afetadas. Embora qualquer osso possa ser envolvido, as falanges da mão são o local mais comum. FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 928Pg. 62. Na fratura da cabeça do fêmur PIPKIN I, o tratamento cirúrgico indicado é a A) artroplastia total. B) artroplastia parcial. C) fixação do fragmento fraturado. D) ressecção do fragmento fraturado. For isolated Pipkin type I fracture with excellent (less than 1-mm step-off) reduction, closed treatment is recommended. One to 4 weeks of light traction (Buck’s skin traction or skeletal traction) followed by touch-down weight-bearing on crutches for 4 weeks has produced good results in most patients.5,13 If the reduction is not adequate, ORIF with small cancellous21 bioabsorbable or Herbert20,55 screws is recommended, using an anterior approach. Herbert screws provide less compressive force across large
cancellous surface areas than do standard small-fragment crews.55 In polytrauma cases, ORIF may also be indicated even when the reduction is good to allow mobilization of younger patients. FONTE:Jupiter J:. Skeletal Trauma 4th Ed. 1613 Pg. 63. O tratamento ideal para a fixação cirúrgica da fratura da diáfise do fêmur, pelo princípio da estabilidade relativa, é A) haste fresada B) fixador externo C) haste sem fresar D) placa percutânea Definitive treatment of these fractures is operative and options include external fixation, intramedullary nailing (IM) and plating. A locked intramedullary nail inserted by a reamed technique is the gold standard for the management of femoral fractures. FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 2678 Pg. 64. Na fratura da epífise proximal da tíbia fechada com lesão vascular associada, o mecanismo de trauma mais comum é A) o varo. B) o valgo C) a flexão. D) a hiperextensão. Physeal fractures are often seen after a hyperextension force resulting in the metaphyseal portion of the tibia displacing posteriorly toward the popliteal artery. Valgus stress can open the physis medially with the bula acting as a lateral resistance force 54 (Fig. 29-1). Rarely, a flexion force can cause a Salter – Harris type II or III fracture.
FONTE: Rockwood and Wilkins's Fractures in Children 8th Ed. 1453 Pg. 65. Na fratura diafisária do fêmur, o compartimento da coxa com maior risco de evoluir com síndrome compartimental é o A) lateral. B) medial. C) anterior. D) posterior. Closed so tissue injuries range from minor contusions to major closed degloving injuries and compartment syndrome, as describ ed by Tscherne. 19 With regard to compartment syndrome, the anterior compartment has been found to be the most commonly affected.
FONTE:Jupiter J:. Skeletal Trauma 4th Ed. 1613 Pg. 66. Nas lesões do anel pélvico, a presença do sinal de GREY TURNER é indicativo de A) fratura dos ramos. B) hemorragia retroperitoneal. C) síndrome de MORELL LAVALLEÉ. D) lesão do trato geniturinário. Flank ecchymosis, or the Grey Turner sign, is indicative of retroperitoneal hemorrhage . Careful examination of the patient with a pelvic ring fracture should be undertaken to include neurovascular assessment of the lower extremities, inspection of the skin to rule out open wounds, examination of the perineum for ecchymosis or frank blood, and palpation of the soft tissues to assess for fluctuant areas indicating potential degloving (Morel-Lavallee) injuries.
FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 1801 Pg. 67. Na lesão do ligamento colateral lateral do tornozelo do tipo III, o melhor tratamento é o A) cirúrgico com reparo ligamentar direto. B) cirúrgico com reforço com aponeurose local. C) não cirúrgico com repouso, gelo e elevação do membro. D) não cirúrgico com imobilização por 4 semanas sem carga. Most patients with complete grade III tears obtain good results regardless of the type of treatment. For those patients with complete tears of the lateral ligaments, functional treatment should be initiated consisting of a short period of protection with taping or bracing that allows early weight bearing, followed by functional range-of- motion exercises and neuromuscular training of the ankle.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 11th ED. 4218Pg
68. A doença de LEGG-CALVÉ-PERTHES é mais comum no sexo A) feminino e bilateral. B) feminino e unilateral. C) masculino e bilateral. D) masculino e unilateral. It is more common in boys than in girls by a ratio of4 or 5 to 1 (25). The incidence of bilaterality has been reported as 10% to 12% (24, 26).
FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 1113 Pg. 69. Faz parte dos critérios de CODMAN para o diagnóstico de capsulite adesiva A) limitação da rotação interna. B) atrofia dos músculos espinhais. C) dor próxima ao processo coracoide. D) incapacidade para dormir sobre o ombro oposto.
FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 1188 70. A fratura do colo do fêmur no adulto é mais frequente em mulheres da raça A) negra com índice de massa corpórea > 18,5. B) negra com índice de massa corpórea < 18,5. C) branca com índice de massa corpórea > 18,5. D) branca com índice de massa corpórea < 18,5. Femoral neck fractures occur most frequently in elderly female patients. They are uncommon in patients younger than 60 years. There is some racial variation in the incidence. They are less common in black races270 and more common in black females than in males.234 Currently, these fractures are most common in the white populations of Europe and North America. Modifiable lifestyle risk factors increasing the risk of hip fractures include a low body mass index (<18.5), low sunlight exposure, low recreational activity, smoking, and alco- hol abuse. FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 535 Pg. 71. Na fratura do calcâneo em língua com grande desvio, a complicação precoce mais frequente é a A) exposição óssea. B) síndrome compartimental. C) necrose da pele posterior. D) lesão do nervo plantar medial. Skin Necrosis Secondary to Displaced Tongue Fractures. When a tongue fragment is significantly displaced, pressure on the posterior skin may occur, causing necrosis if left untreated. Gardner et al.62 recently presented a series of 137 tongue fractures with 21 cases exhibiting posterior skin necrosis. In those fractures treated emergently with percutaneous reduction and temporary Kirschner wire (K-wire) stabilization,
soft tissue compromise did not occur. The authors concluded that because of the high incidence of posterior skin compromise in tongue-type calcaneus fractures, consideration should be given to immediate percutaneous reduction and temporary stabilization, plantarflexion splinting, and close monitoring (Fig. 61-3). FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 535 Pg. 72. Na luxação patelar intra-articular, a superfície articular da patela está comumente A) horizontalizada e voltada para a tíbia. B) horizontalizada e voltada para o fêmur. C) verticalizada e voltada para o côndilo lateral. D) verticalizada e voltada para o côndilo medial. INTRAARTICULAR DISLOCATIONS OF THE PATELLA
Intraarticular dislocations of the patella are rare and are of two types. The most common type is a horizontal intraarticular dislocation of the patella with detachment of the quadriceps tendon; the articular surface of the patella is directed toward the tibial articular surface (Fig. 60-3). FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 3020 Pg. 73. Na artroplastia total do quadril, durante a cimentação, a complicação que diminuiu consideravelmente com a melhora das técnicas de anestesia foi A) o broncoespasmo. B) a queda da pressão arterial. C) a trombose venosa profunda. D) o tromboembolismo pulmonar.
FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 2418 74. A complicação mais frequente após fratura do capítulo umeral é a A) pseudartrose. B) necrose avascular. C) consolidação viciosa. D) diminuição da mobilidade articular. FONTE:Jupiter J:. Skeletal Trauma 4th Ed. 2373 Pg.
75. Na rizartrose o principal ligamento que se torna incompetente para estabilizar a articulação acometida é o A) ulnar. B) dorsal. C) palmar. D) intermetacarpal.
FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 1797
76. A pseudartrose congênita da tíbia apresenta alteração histológica
A) no periósteo e é composta por neurofibroma. B) no periósteo e é composta por tecido fibroso. C) na medular óssea e é composta por tecido fibroso. D) na medular óssea e é composta por neurofibroma. Because of their association with either neurofibromatosis or fibrous dysplasia, one might expect these lesions to be found microscopically in the area of the pseudarthrosis site. Although such a finding has been reported,81 most investigators have failed to find anything other than thickened fibrous tissue at the pseudarthrosis site,27,44 accompanied by a paucity of vascular ingrowth.85 The fact that the fibrous constriction lesion is universally present has suggested to some investigators that the primary pathologic lesion is in the periosteal structures around the tibia rather than in the bone itself .1,2 FONTE (OFICIAL) : Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 542 PG FONTE (CORRIGIDA) : Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 742 PG 77. Na deformidade de SPRENGEL, o tratamento cirúrgico deve incluir a ressecção do osso omovertebral de modo A) subperiosteal e depois dos 3 anos de idade. B) subperiosteal e antes dos 3 anos de idade. C) extraperiosteal e depois dos 3 anos de idade. D) extraperiosteal e antes dos 3 anos de idade. Surgery is indicated in children with severe aesthetic and functional limitations. Surgery does not correct the scapular hypoplasia but is indicated for improving shoulder motion by restoring more normal positioning of the scapula and the glenoid. This often consists of excising any omovertebral connections and surgically derotating and caudally relocating the scapula. Most of the procedures that are described include extraperiosteal resection of the superior pole of the scapula (130, 132). Subperiosteal resection is associated with a high rate of recurrence (133, 134). In addition to functional indications for surgery, most patients and families welcome the improvement in the appearance of the neck line. In the mild deformities, extraperiosteal excision of the superior pole of the scapula and any omovenebral connections alone may be satisfactory treatment. In the moderate and severe deformities, the scapula is also derotated and moved more distally in order to bring the glenoid into a more vertical orientation. The purpose of surgery is to improve the neck contour along with shoulder motion and function. Indications for functional improvement have been cited for preoperative abduction <110 to 120 degrees (129, 135). Surgery is recommended most often in patients between 3 and 8 years of age (136-138). Fonte: FONTE: Lovell and Winter's Pediatric Orthopaedics 7th Ed 914 Pg. 78. Na marcha normal, as fases de balanço e de apoio ocupam o ciclo, respectivamente, em A) 70% e 30% B) 30% e 70% C) 40% e 60% D) 60% e 40% The gait cycle is divided into two phases, stance and swing. Stance phase occupies 60% of the gait cycle and swing phase occupies 40% FONTE: Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 71 PG
79. A síndrome de SINDING-LARSEN-JOHANSSON acomete com maior frequência A) meninas entre 6 e 10 anos. B) meninos entre 6 e 10 anos. C) meninas entre 10 e 14 anos. D) meninos entre 10 e 14 anos. A Síndrome de SINDING-LARSEN-JOHANSSON é uma osteocondrose juvenil que se apresenta com mais frequência em adolescentes meninos, entre os 10 e 14 anos. Afeta o polo inferior da patela, na inserção proximal do tendão patelar. FONTE: Sizínio e Hebert 2017 Ed. 1114 Pg. 80. No exame físico do joelho, são manobras indicadas para a avaliação de lesões meniscais os testes de A) GODFREY e CLARKE. B) STEINMANN e CLARKE. C) MCMURRAY e GODFREY. D) STEINMANN e MCMURRAY.
FONTE: Tarcísio et. Al Exame Físico 2ª. Ed. 256-57 Pg.
81. A localização clássica da osteocondrite dissecante do joelho do adolescente é a área A) medial do côndilo femoral lateral. B) medial do côndilo femoral medial. C) lateral do côndilo femoral lateral. D) lateral do côndilo femoral medial. Osteochondritis dissecans of the knee is characterized by the presence of an area along the femoral articular surface consisting of cartilage and bone that may be softened or may become loose and separated from the resto f the femoral condyle. Most lesions are located on the lateral side of the medial femoral condyle and range in size from a few milimeters to 2 to 3 centimeters in diameter. FONTE: Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 694 PG 82. No tratamento da fratura subtrocantérica com redução adequada, o colapso em varo é menos frequente usando-se A) DCS. B) placa angulada. C) haste intramedular. D) placa trocantérica bloqueada. O pilar do tratamento para fraturas subtrocantéricas do fêmur é a haste intramedular. Há evidências de q ue os implantes intramedulares são superiores aos implantes extramedulares no tratamento da maior parte das fraturas nessa difícil região
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2137Pg. 83. Nas lesões fisárias da extremidade proximal do úmero do tipo II de SALTERHARRIS, o fragmento metafisário tem como localização mais frequente a região A) anterolateral. B) anteromedial. C) posterolateral. D) posteromedial. This anatomic characteristic, in addition to the relative thickness of the posteromedial periosteum and thinness of the anterolateral periosteum, may help explain the tendency for the metaphyseal fragmente to buttonhole the periosteum anterolaterally when the proximal end of the humerus is fractured and (in Salter-Harris type II injuries) for a small posteromedial piece of metaphysis to stay with the proximal fragment. FONTE:Jupiter J:. Skeletal Trauma 5th Ed. 257-58 Pg. 84. A fratura diafisária do úmero na criança é mais frequentemente encontrada na faixa etária entre A) 0 e 3 anos. B) 3 e 6 anos. C) 6 e 9 anos. D) 9 e 12 anos. The humeral shaft is fractured less frequently in children that in adults. Among the humeral shaft fractures of childhood, diaphyseal fractures are more common in children older than 12 or younger than 3 years. FONTE:Jupiter J:. Skeletal Trauma 5th Ed. 263 Pg.
85. Nas fraturas da diáfise do fêmur em crianças, o desvio do fragmento proximal se dá em A) flexão, adução e rotação lateral. B) flexão, abdução e rotação lateral. C) extensão, adução e rotação medial. D) extensão, abdução e rotação medial. A: In the resting unfractured state, the positionof the femur is relatively neutral because of balanced muscle pull. B: In proximal shaft fractures the proximal fragment assumes a
position of flexion (iliopsoas), abduction (abductor muscle group), and lateral rotation (short external rotators). C: In midshaft fractures the effect is less extreme because there is compensation by the adductors and extensor attachments on the proximal fragment. D: Distal shaft fractures produce little alteration in the proximal fragment position because most muscles are attached to the same fragment, providing balance. E: Supracondylar fractures often assume a position of hyperextension of the distal fragment because of the pull of the gastrocnemius. FONTE: Rockwood and Wilkin’s fractures in children 8th Ed. 990 Pg. 86. O músculo vasto lateral é inervado e vascularizado, respectivamente, pelo nervo A) femoral e artéria femoral profunda. B) obturador e artéria femoral profunda. C) femoral e artéria femoral superficial. D) obturador e artéria femoral superficial. FONTE: European Surgical Orthopaedics and Traumathology – The EFORT Textbook 2014 Ed. 2664Pg. 87. A complicação mais frequente após amputação nos membros superiores é A) falha da miodese. B) contratura articular. C) ossificação heterotópica. D) dor do membro fantasma. Pain Management in the Upper Extremity Amputation Chronic pain is a frequent complication of traumatic upper extremity amputations. The prevalence of pain in the residual limb after upper extremity amputation is reported in 7% to 49% of patients. Phantom limb pain is reported in 30% to 79% of upper extremity amputees, with most authors reporting greater than 50% prevalence.23,50-55 Despite this, chronic pain has not been shown to significantly impact functional prosthetic wear or return to employment as one might expect.37 FONTE: Jupiter J:. Skeletal Trauma 5th. 2519 Pg. 88. A ossificação do fêmur e da tíbia ocorre durante a gestação nas semanas A) 5 e 6. B) 7 e 8 C) 9 e 10. D) 10 e 11.
FONTE: Lovell and Winter’s Pediatric Orthopaedics 7Ed. 9Pg. 89. No tratamento cirúrgico do pé plano, a artrorrise é um procedimento caracterizado pelo A) bloqueio definitivo da articulação subtalar. B) bloqueio temporário da articulação subtalar. C) bloqueio definitivo da articulação talonavicular. D) bloqueio temporário da articulação talonavicular. Arthroereisis. Arthroereisis of the subtalar joint, using a silicone or Silastic implant, has been reported as an alternative to more complex joint reconstruction. The rationale of the procedure is to limit the amount of valgus motion in the subtalar joint by using an interposition peg. Long-term results of this procedure are lacking, and because of potential complications of intraarticular placement of Silastic material, especially in the normal cartilaginous surfaces of a child’s hindfoot, this procedure is not
warranted given that the natural history of a flexible flatfoot is generally benign.1,20,39,41 Nevertheless, the use of silicone or Silastic material interposed in the subtalar joint is common in the podiatric literature.1,21,35,39 The potential for synovitis necessitating implant removal is real (Fig. 23-32). FONTE: Herring: Tachdjian’s Pediatric Orthopaedics 5th. 780 Pg. 90. A supinação do pé envolve movimentos de A) adução, inversão e flexão. B) abdução, eversão e flexão. C) adução, inversão e extensão. D) abdução, eversão e extensão.
FONTE: Tarcisio et.al Exame Físico 2 ed 269 Pg. 91. Na lesão fisária traumática, o aparecimento das linhas de HARRIS representa A) consolidação viciosa. B) retarde de consolidação. C) aceleração do crescimento. D) retarde ou parada do crescimento. Harris is credited with the first radiographic observation of bony striations in the metaphysis of long bones.123 These Harris growth arrest lines are transversely oriented condensations of normal bone and are thought to represent slowing or cessation of growth corresponding to times of illness, injury, or healing. They may be present in a single bone after an isolated traumatic injury or in all long bones after a significant systemic illness. When present after a physeal injury, they serve as an effective representation of the health of the physis FONTE: Herring: Tachdjian’s Pediatric Orthopaedics 5th. 1203 Pg. 92. Na lesão pélvica da criança, a presença de fratura bilateral dos ramos púbicos, segundo a classificação de TORODE e ZIEG, corresponde ao tipo
A) I. B) II. C) III. D) IV. R= In their 1985 report on a series of 141 pelvic fractures, Torode and Zieg improved on the Watts classification and expanded it as follows: Type I—avulsion fractures Type II—iliac wing fractures Type III—simple ring fractures, including pubic symphysis diastasis without disruption of the posterior SI joint Type IV—any fracture pattern that creates a free bony fragment, including bilateral pubic ramus fractures, fractures of the anterior pelvic ring with an acetabular fracture, and pubic ramus fractures or pubic symphysis disruption with a fracture through the posterior bony elements or disruption of the SI joint FONTE: Skeletal Trauma in Children 5 th ed. 316 Pg 93. Na luxação traumática irredutível do joelho, as estruturas mais comumente interpostas são A) os tendões da pata de ganso. B) a cápsula e o ligamento colateral tibial. C) a cápsula e o ligamento colateral fibular. D) o trato iliotibial e o tendão do bíceps femoral. The examiner should carefully examine the skin for lesions that may give clues to the nature of the injury, such as prepatellar abrasions consistent with a “dashboard” injury . Rarely, incarceration of the medial capsule and even the medial
collateral ligament (MCL) can prevent concentric reduction of the joint. In this case, the examiner may be alerted to the presence of an “irreducible” dislocation by the presence of skin dimpling on the medial aspect of the knee. Such cases require immediate open reduction FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 2372 Pg.
94. Na anatomia da coluna vertebral, a artéria de ADAMKIEWICZ está localizada mais frequentemente entre os níveis A) T7-T9 e à direita. B) T9-T11 e à direita. C) T7-T9 e à esquerda. D) T9-T11 e à esquerda Artery of Adamkiewicz. The artery of Adamkiewicz is the largest of the feeders of the lumbar cord; it is located on the left side, usually at the level of T9-11 (in 80% of individuals). The anterior longitudinal arterial channel of the cord rather than any single medullary feeder is crucial. The preservation of this large feeder does not ensure continued satisfactory circulation for the spinal cord. In principle, it would seem of practical value to protect and preserve each contributing artery as far as is surgically possible.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 13th ED. 1577Pg. 95. Na consolidação viciosa com deformidade angular tratada com fixação externa circular, a colocação da dobradiça no lado convexo da bissetriz do CORA leva a A) cunha de abertura. B) cunha de fechamento.
C) rotação dos fragmentos. D) translação dos fragmentos. When the osteotomy plane passes through the convex cortex CORA and an opening wedge angular correction of the magnitude of deformity is performed, the proximal and distal anatomic and mechanical axes of the bone become colinear, and normal joint orientation is restored between the distal and proximal joints of that bone. The same correction is achieved when a closing wedge osteotomy of the magnitude of angulation converges on the concave cortex CORA FONTE:Jupiter J:. Skeletal Trauma 4th Ed. 2373 Pg. 96. Na osteotomia de CHIARI do quadril, a complicação hemorrágica mais frequente ocorre por lesão da artéria A) glútea inferior. B) glútea superior. C) circunflexa femoral lateral. D) circunflexa femoral medial. Intra-Operative Complications: Stronger bleeding will cease when the osteotomy is medialised. This is due to haemorrhage from the superior gluteal artery. Bleeding from other major vessels has not yet been reported. Excessive displacement with central dislocation is extremely unusual. Restoration begins by screwing a femoral head extractor, such as that used for total hip arthroplasty, into the greater trochanter. It is then pulled laterally under adduction and forced extension of the leg. After successful re-positioning, the osteotomy is transfixed as described above. FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 2341 97. Na via de acesso para região anterior e proximal do antebraço (HENRY), o plano intermuscular encontra-se entre os músculos braquiorradial, A) braquial e pronador redondo. B) braquial e flexor longo do polegar. C) pronador redondo e flexor profundo dos dedos. D) flexor profundo dos dedos e flexor longo do pol egar. Após a incisão de pele e subcutâneo, a abertura longitudinal da fáscia identifica o intervalo muscular proximal entre o braquiorradial e o braquial (junto ao tendão do bíceps). Distalmente, a dissecção continua entre o braquiorradial e o pronador redondo, que vem descendo de medial para lateral. Retraindo-se o braquiorradial com cuidado, identifica-se o nervo radial já dividido proximalmente à altura do epicôndilo lateral em ramo superficial (sensitivo) e ramo interósseo posterior (motor). Esse último penetra no músculo supinador pela arcada de Frohse
FONTE: Sizínio e Hebert 2017 Ed. Parte IV – Cap 78 – vias de acesso ao membro superior – hotsite 98. A amputação do terceiro raio da mão compromete no polegar o movimento de A) flexão. B) adução. C) abdução. D) extensão. Excising the third metacarpal shaft removes the origin of the adductor pollicis and weakens pinch. The index ray should not be transposed unless this adductor can be reattached elsewhere. The operation is contraindicated if the hand is needed for heavy manual labor. FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 724 Pg. 99. Na fratura “em galho verde” da metáfise proximal da tíbia, a deformidade mais frequente é o
A) varo. B) valgo. C) recurvato. D) antecurvato. Proximal tibial metaphyseal fractures are relatively uncommon injuries that generally occur in children between 3 and 6 years of age (range, 1 to 12 years). The male-to-female ratio of approximately 3:1 closely parallels the incidence of tibial fractures by gender in children. These fractures are typically the result of a direct injury to the lateral aspect of the extended knee. Most of these fractures have minimal or no displacement and appear benign radiographically; however, they may, in fact, be followed by a posttraumatic valgus deformity. Greenstick and complete fractures are most commonly associated with a valgus deformity . Such deformities are unusual after a torus fracture. In a greenstick fracture, the medial cortex (tension side) fractures while the lateral cortex (compression side) remains intact or hinges slightly. If the lateral cortex hinges, a valgus deformity occurs. FONTE: Skeletal Trauma in Children 5th Ed. 439 Pg.
100. Na lesão crônica de ESSEX LOPRESTI, indica-se o A) encurtamento da ulna e ressecção da cabeça do rádio. B) encurtamento da ulna e artroplastia da cabeça do rádio. C) alongamento do rádio e reinserção da fibocartilagem triangular. D) alongamento do rádio e ressecção da extremidade distal da ulna. In chronic and longstanding cases, IOL reconstruction would seem logical, but only in combination with restoration of t he integrity of all forearm stabilizers at the same time as the recreation of a level DRUJ and zero ulnar variance . Restoring this relationship between radius and ulna may require ulnar shortening osteotomy with simultaneous radial head prosthetic replacement to prevent further proximal radial migration. Of course, this approach only addresses the skeletal components. FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 1546
