She is currently taking sulfasalazine, Penicillamine, and etanercept, a tumor necrosis factor inhibitor (aTNF-a). "spur sign" is pathognomonic. ORIF & Subtalar Fusion for Ankle Fracture. Which of the following is the best dosing recommendation for her antirheumatic medications prior to surgery? She enjoys walking however is limited to 2 blocks due to pain. Supramalleolar osteotomy is a joint-preserving surgical treatment for patients with asymmetric valgus or varus ankle arthritis. Plan surgery at the end of dosing +1 week interval (~13 weeks last dose). : Michael Clare, MD (CSFA #4, 2017). (OBQ10.263) Tracking tools monitor your progress and help you learn more efficiently by decreasing redundancy in the future. 1 +) a (extremely rare, rare, common) (congenital, degenerative, acquired, traumatic) CONDITION. Total Ankle Arthroplasty. S. Raikin. Stop 1-2 days before for major procedures. Figure B displays her hand maintaining her fingers extended following passive extension. Thank you. Figure A displays her hand during active extension of all fingers. Rheumatoid Arthritis is a chronic systemic autoimmune diseasecaused by IgM cell-mediatedimmune response against soft tissues, cartilage, and bone. A radiograph is shown in Figure B. Diagnosis is made with an aspiration of joint fluid with a WBC count > 50,000 being considered diagnostic for septic arthritis. Orthobullets Team Trauma . origin is 10mm proximal to tip of fibula. (OBQ12.137) A 65-year-old man complains of ankle pain refractory to bracing, physical therapy and NSAIDS. main . Patients present with insidious onset ofmorning joint stiffness, polyarthropathy. He shows no evidence of healing at 12 months postoperatively and has continuous pain with ambulation; his incisions are well-healed and his subtalar motion remains full and pain-free upon examination. Diagnosis is primarily made with plain radiographs of the ankle. The most common complications are development of subtalar arthritis and nonunion. Stop 1-2 days before major procedures, restart 1-2 wks after. , with progressive hand and wrist deformity. Post-traumatic ankle arthritis can be a very disabling condition especially in young patients. Rheumatoid Arthritis is a chronic systemic autoimmune disease caused by IgM cell-mediated immune response against soft tissues, cartilage, and bone. Treatment can be nonoperative or operative depending on patient age, patient activity demands . Ankle arthrodesis is the fusion of the tibiotalar joint most commonly performed for end-stage arthritis of the joint. (OBQ13.191) Mullaji AB, Shetty GM, Kanna R, the earliest manifestation of rheumatoid arthritis of the forefoot is synovitis of the MTP joints with eventual hyperextension deformity of the MTP joints including distal migration of the forefoot pad, painful plantar callosities and skin ulcerations over bony prominences. Midfoot prominences associated with Charcot arthropathy, End-stage tibiotalar arthritis with limited motion. main feature is a vertical shear fracture of the posteromedial tibial rim. The single rocker sole shoe modification is best indicated for relief of pain in patients with what foot or ankle pathology? Which of the following management options for the finger MCP joints most likely lead to the least amount of extensor lag and improvement of the ulnar drift at 1-year followup? Other common symptoms of ankle arthritis include: 1. What is the most important consideration in the preoperative evaluation of a child with polyarticular or systemic juvenile rheumatoid arthritis (JRA)? No antibiotics were added to the irrigating solution. Treatment is primarily medical management with NSAIDS, DMARDS, biologics, antimalarials, and steroids. (OBQ08.89) She currently takes etanercept weekly and hydroxychloroquine daily. Which of the following options will most likely provide pain relief and allow her to return to her previous activity level? (OBQ08.197) For pure ankle dislocations, the overall prognosis is favorable. Which of the following medications when combined with methotrexate has been shown to be more effective than methotrexate alone in the treatment of rheumatoid arthritis? Septic Arthritis - Adult. Orthobullets.com is a Health website . most common etiology, accounting for greater than 2/3 of all ankle arthritis, accounts for less than 10% of all ankle arthritis, other etiologies include rheumatoid arthritis, osteonecrosis, neuropathic, septic, gout, and hemophiliac, nonanatomic fracture healing alters the joint contact forces of the ankle and changes the load bearing mechanics of the ankle joint, loss of cartilage on the talar body and tibial plafond results in joint space narrowing, subchondral sclerosis and eburnation, a ginglymus joint that includes the tibia, talus, and fibula, talar dome is biconcave with a central sulcus, Early sclerosis and osteophyte formation, no joint space narrowing, Narrowing of medial joint space (no subchondral bone contact), Obliteration of joint space at the medial malleolus, with subchondral bone contact, Obliteration of joint space over roof of talar dome, with subchondral bone contact, Obliteration of joint space with complete tibiotalar contact, pain with ROM testing, loss of ROM compared to the contralateral side, angular deformity may be present depending on the history of trauma, activity modification, bracing to immobilize the ankle, and NSAIDS, indicated as first line of treatment in mild disease, indicated upon failure of conservative treatment in a patient with radiographic evidence of ankle arthritis, ideal candidate younger than 45 yrs with post-traumatic arthritis, minimal talar-tilt or varus heel alignment, stage 2 or 3a according to the Takakura-Tanaka classification for varus-type osteoarthritis, posttraumatic or inflammatory arthritis, malalignment (with osteotomy), reliable relief of pain and return to activities of daily living, 50% of patients demonstrated subtalar arthrosis 10 years following ankle arthrodesis in one study, risk factors for nonunion include smoking, adjacent joint fusion, history of failed previous arthrodesis, and avascular necrosis, revision arthrodesis union rates are 85% or greater, posttraumatic or inflammatory arthritis, elderly patient, uncorrectable deformity, severe osteoporosis, talus osteonecrosis, charcot joint, ankle instability, obesity, and young laborers increase the risk of failure and revision, new generation arthroplasty minimizes bony resection, retains soft tissue stabilizers, and relies on anatomic balancing, recent 5-10 year outcome studies demonstrate up to 90% good to excellent clinical results, long-term studies are still pending on the newest generation of ankle arthroplasty, include wound infection, deep infection, and osteolysis. An injection into her ankle joint provided temporary near-complete relief. fracture-dislocation of the ankle due to hyperplantarflexion. Ankle distraction arthroplasty is an innovative procedure for treating ankle arthritis in select patients. (OBQ09.179) Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Midfoot Arthritis is defined as arthritis of the midfoot which includes the following joints: naviculocuneiform joint, intercuneiform joints, and metatarsal cuneiform joints. (OBQ11.17) A 25-year-old male sustains an ankle fracture dislocation and undergoes open reduction and internal fixation. All rights reserved, Total Ankle Arthroplasty: Summary of Current Status, Kathryn OConnor 1University of Pennsylvania, USA See all articles by this author Search Google Scholar for this author, American Orthopaedic Foot & Ankle Society (AOFAS) Evidence-Based Medicine Committee. MB BULLETS Step 1 For 1st and 2nd Year Med Students. (OBQ13.169) (OBQ13.254) Which of the following medications specifically target tumor necrosis factor alpha (TNF-a)? 2022 Lineage Medical, Inc. Midfoot Arthritis. Restart >14 days postoperatively. IP fusion and MCP arthroplasty (if CMC is diseased), Boutonniere with CMC subluxation (uncommon, deformity primarily at CMC), Swan neck deformity (MCP hyperextension, IP flexion), Stage 3: MCP fusion with first web release, Gamekeeper deformity (metacarpal adduction, radial deviation of P1 with lax volar plate and UCL), Stage 1 (passively correctable): synovectomy, UCL reconstruction, and adductor fascia release, Stage 2 (fixed deformity) MP arthroplasty or fusion, Swan neck with MCP disease (MCP volar plate laxity), MP stabilized in flexion by volar capsulodesis, Skeletal collapse (arthritis mutilans) (MCP volar plate laxity), FDS4 to FPL tendon transfer + excision of scaphoid spurs (may also lead to rupture index FDP2), frequency EDM > EDC (ring) > EDC (small) > EPL, extensor tendons migrate slip into ulnar gutter and volar to center of rotation of MCP joint, if MCP placed in extension actively then patient can hold extended, sagittal band reconstruction (extensor hood reconstruction), rupture of digital extensor tendons from ulnar to radial, DRUJ instability + volar carpal subluxation results in dorsal ulnar head prominence and attritional rupture of the extensor tendons, Differentials for loss of digital extension, extensor tendon subluxation (torn radial sagittal band), to EDC5 or EDQM to EDC piggyback transfer, must also relocate ECU dorsally with a retinacular flap or perform ECU stabilization of ulna, synovitis and capsular distension leads to, ulnar and volar translocation of the carpus on the radius, with scaphoid flexion, radiolunate widening, lunate translocation (ulnarwards), ulnar deviation of the fingers at the MP joints creating the classic zigzag deformity, transfer of ECRL to ECU to diminish deforming forces (Clayton's procedure), advantages over fusion is motion and best in patients with reasonable motion preop, rheumatoid elbow is mainly managed with medical management and cortisone injections, focus of degeneration is in radiohumeral joint, posterior interosseous nerve compression secondary to radial head synovitis, performed through lateral approach to elbow, young active patients who are not candidates of TEA, resection and contouring of humeral surface, cover humeral surface with cutis autograft, Achilles tendon, fascia, or dermal allograft, some use distraction external fixator to unload membrane and enhance its bonding to bone and improve motion, results less predictable than TEA, but avoids prosthetic complications, reliable procedure for advanced RA of elbow, 5 lb single arm weight lifting restriction, RA is most prevalent form of inflammatory process affecting the shoulder with >90% developing shoulder symptoms, commonly associated with rotator cuff tears, decreases pain and swelling but does not alter prevent radiographic progression and does not prevent the need for TKA in the future, normal synovium reforms, but degenerates to rheumatoid synovium over time, rheumatoid arthritis is considered an indication for resurfacing of the patella during total knee arthroplasty, forefoot joints are the first to be affected, human leukocyte antigen (HLA)-DR4 positive. Inhibition of dihydrofolate reductase (DHFR), Monoclonal antibody against CD20 on B-cell surface. if diagnosis is clinical below, drop most common presentation here. Psoriatic Arthritis is a seronegative spondyloarthropathy that presents with DIP predominant arthritis of the hands, rash with silvery plaques, uveitis, and dysmorphic nails. You can rate this topic again in 12 months. An active 70-year-old female presents to your office with increasing foot pain over the last several years. Ankle Arthritis is degenerative joint disease of the tibiotalar joint that can be broken into three main types: osteoarthritis, post-traumatic arthritis, and inflammatory arthritis. (OBQ18.99) 3+) The condition typically PRESENTS IN (children, adolescents, young adults, adults, elderly) 4) PRESENTS WITH most common symptoms and or finding). (OBQ11.190) Physical exam. Copyright 2022 Lineage Medical, Inc. All rights reserved. most common extra-articular manifestation of RA, seen in 25% of patients with RA and associated with, erosion through skin may lead to formation of sinus tract, patients complain of pain and cosmetic concerns, cosmetic concerns, pain relief, diagnostic biopsy, seen in patients with RA or psoriatic arthritis, digits develop gross instability with bone loss (, treated with interposition bone grafting and fusion, volar subluxation associated with ulnar drifting of digits, extrinsic extensor tendons subluxate ulnarly, lax collateral ligaments allow ulnar deviation deformity, ulnar intrinsics contract further worsening the deformity, thumb MCP involvement + thumb IP involvment, important to correct wrist deformity at same time if it is radially deviated, synovectomy, volar capsular resection, ulnar collateral ligament release, radial collateral ligament repair/reconstruction, extensor tendon realignment, intrinsic tendon release, 1 year followup shows improved ulnar drift and extensor lag, thumb MCP involvement without IP involvement, FDS, volar plate and collateral ligament attenuation, contracture of triangular ligament, attenuation of, for flexible PIP (prevent hyperextension), Nalebuff Classification of Rheumatoid Thumb Deformities, Stage 1: Synovectomy with extensor hood reconstruction, Stage 3: IP and MCP fusion (if CMC is normal). This domain provided by register.com at 2006-01-30T21:41:22Z (16 Years, 307 Days ago) , expired at 2026-01-30T21:41:22Z (3 Years, 58 Days left). . Anatomy. He is treated with ankle arthroplasty but continues to have pain and limited ambulation 10 months following surgery. 1) STEPS - reading the Orthobullets "Steps" of a skill that have been created by orthobullets. The triple arthrodesis is a versatile procedure useful in many pedal conditions and gait disturbances. Acta Orthop Belg 2011;77 (3):329-335. Diagnosis is primarily made with plain radiographs of the ankle. What is the next most appropriate treatment for the ring finger? Hunter syndrome (type II mucopolysaccharidosis), 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Hand Manifestation of Rheumatoid Arthritis - Michael Firtha, DO, Arthrodesis & Arthroplasty of Small Joints of the Hand - Shaan Patel, MD, Cleveland Combined Hand Fellowship Lecture Series 2019-2020, Small Joints Arthroplasty vs Arthrodesis - Imad Abushahin, MD, Basic Science | Rheumatoid Arthritis of the Elbow (ft. Dr. Matthew L. Ramsey), Hip pain with an unusual pelvic XRay in a 68M. Medical treatment targeting TNF-alpha has revolutionized which of the following diseases? FORE 2022 11th Annual Current Solutions in Foot & Ankle Surgery. What is the most appropriate treatment? 79% sensitive, 100% specific. Thank you. Dynamization of the implants to allow controlled compression, Removal of the implants and placement of a hindfoot arthrodesis nail or plate, Revision ankle arthrodesis with bone grafting as needed. (OBQ09.162) TNF antagonists (etanercept, infliximab, adalimumab). A 64-year-old female with rheumatoid arthritis has decreased functional use of the left hand for activities of daily living. She has tried orthotics and custom shoes but notes worsening foot pain that is limiting her daily activities. He returns to clinic five months following surgery complaining of continued ankle pain and instability with weight bearing. Complete obliteration of the ankle joint space with bone-on-bone contact; valgus ankle alignment, No joint-space narrowing, but early ankle joint sclerosis and osteophyte formation; valgus ankle alignment, Symptomatic narrowing of the ankle joint space medially; varus ankle alignment, Symptomatic narrowing of the ankle joint space laterally; neutral ankle alignment, Obliteration of the medial joint space that extends to the roof of the talar dome; varus ankle alignment. 2+) CAUSED BY what causes it from pathophysiology section THAT LEADS TO. Which immunoglobulin subtype does the rheumatoid factor target? Orthobullets Septic Joint will sometimes glitch and take you a long time to try different solutions. Body weight, degree of foot swelling, arthritis index, immune organ index, synovial histopathological changes, and serum levels of tumor necrosis factor-(TNF-), interleukin-1(IL-1), and interleukin-6(IL-6) were observed. Diagnosis is made with a combination of physical examination, characteristic radiographs, and labs to evaluate for presence of RF andanti-CCP antibodies. What changes should be made to her medication regimen prior to surgery? Treatment can be nonoperative or operative depending on patient age, patient activity demands, severity of arthritis, and presence of tibiotalar deformity. Furthermore, you can find the "Troubleshooting Login Issues" section which can answer your unresolved problems and equip you . She has attempted shoe wear modifications, orthotics, physical therapy and non steroidal anti-inflammatories with limited relief of her symptoms. Ankle Arthrodesis. A current radiograph is provided in Figure B. At long-term follow-up, patients undergoing the procedure shown in Figure A have been shown to have significant rates of findings of which of the following? Thank you. Which of the following is the most likely cause of the continued pain? The perioperative use of which medication has been shown to increase the risk of post-operative infection following orthopaedic procedures in patients with rheumatoid arthritis (RA)? Treatment can be nonoperative or operative depending on patient age, patient activity demands, severity of arthritis, and presence of tibiotalar deformity. arthritis can present as isolated knee pain and must be ruled out. A 45-year-old woman with rheumatoid arthritis is being scheduled for a total knee athroplasty in 2 weeks. 3. You can rate this topic again in 12 months. She would like to proceed with a surgical intervention following a shared decision making discussion. Diagnosis is primarily made with plain radiographs of the ankle. Which of the following biologic agents commonly used to treat rheumatoid arthritis (RA) DOES NOT target tumor necrosis factor-alpha (TNF-alpha)? Due to the procedure's predictability, it is often used as a definitive treatment for many pedal . Your personal learning gps. These other procedures, while appropriate in many cases, sacrifice the ankle joint in an effort to decrease pain from arthritis. found that the majority of patients were asymptomatic after appropriate treatment. Which of the following is a contraindication for a total ankle arthroplasty? (OBQ11.10) Diagnosis is made based on a thorough evaluation of serum labs, clinical features, and radiographic findings. (SBQ12FA.39) cervical spine, elbows, ankle and shoulder. Hemophilic Arthropathy. Physical exam is notable for well healed incisions and no instability with anterior drawer and inversion testing. Keller procedure with lesser metatarsal head resections, 1st MTP joint fusion and lesser metatarsal head resections, 1st MTP joint interposition arthroplasty and lesser MTP joint arthroplasties. Request PDF | On Dec 1, 2022, Nuno Vieira da Silva and others published Complex Physeal Fracture of the Distal Tibia - Description of a New Fracture Pattern | Find, read and cite all the research . Treatment can be nonoperative or operative depending on patient age, patient activity demands . Load-sharing device with improved bending stiffness . extends from the anteroinferior border of the fibula to the neck of the talus. Psoriatic Arthritis. Diagnosis is made with plain radiographs of the foot often showing joint space narrowing and dorsal osteophyte formation in the midfoot. All of the following have been recognized as risk factors for nonunion or delayed union following subtalar arthrodesis EXCEPT: more than 2 millimeters of avascular bone at arthrodesis site, prior ipsilateral failed tibiotalar arthrodesis, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list. ORIF of posterior malleolus with antiglide plating. Hemophilic Arthropathy is a systemic arthropathy most commonly caused by hemophilia, and characterized by repetitive hemarthroses and progressive joint disease. Type in at least one full word to see suggestions list, Total Ankle Arthroplasty: Summary of Current Status, Kathryn OConnor 1University of Pennsylvania, USA See all articles by this author Search Google Scholar for this author, American Orthopaedic Foot & Ankle Society (AOFAS) Evidence-Based Medicine Committee, 30th Annual Baltimore Limb Deformity Course, Bone Ninja Demonstration: Ankle Varus - Noman A. Siddiqui, MD. Copyright 2022 Lineage Medical, Inc. All rights reserved. The type of orthotic needs to be specific for the underlying bony or ligamentous pathology in order to provide appropriate functional support. In which of the following scenarios would this procedure be most appropriate? What is the most appropriate treatment for him at this time? rare (incidence annual new case) < 1/200,000, this is the mechanism of injury (valgus force on knee), this is the molecular or cell biology of disease, Insert AO/OTA classification for all Fracture Topics, this is a specific event the patient cites. Kathryn OConnor 1University of Pennsylvania, Posterior Tibial Tendon Insufficiency (PTTI). Medial opening wedge supramalleolar osteotomy is considered a treatment option for ankle osteoarthritis. (SBQ12FA.32) The procedure may be performed with an open approach or arthroscopically. Mastery Trigger: Check the "Mark Skill as Read" under each Step.. ka. summary. STT arthritis us diagnosed clinically with with pain and weakness in grip strength with radiographs showing narrowing and subchondral sclerosis at . Spiral oblique retinacular ligament reconstruction, Triangular ligament and transverse retinacular ligament reconstruction. subcutaneous nodules in 20% (strong association with positive serum RF) ulnar deviation with metacarpophalangeal (MCP) subluxation . fracture-dislocation of the ankle due to hyperplantarflexion. Condition A is (Condition identical in caps to title), 1 +) a (extremely rare, rare, common) (congenital, degenerative, acquired, traumatic). anterior drawer in 20 of plantar flexion. Patients with a fixed flexion deformity on the contralateral knee may benefit from a . most common etiology, accounting for greater than 2/3 of all ankle arthritis, accounts for less than 10% of all ankle arthritis, other etiologies include rheumatoid arthritis, osteonecrosis, neuropathic, septic, gout, and hemophiliac, nonanatomic fracture healing alters the joint contact forces of the ankle and changes the load bearing mechanics of the ankle joint, loss of cartilage on the talar body and tibial plafond results in joint space narrowing, subchondral sclerosis and eburnation, a ginglymus joint that includes the tibia, talus, and fibula, talar dome is biconcave with a central sulcus, Early sclerosis and osteophyte formation, no joint space narrowing, Narrowing of medial joint space (no subchondral bone contact), Obliteration of joint space at the medial malleolus, with subchondral bone contact, Obliteration of joint space over roof of talar dome, with subchondral bone contact, Obliteration of joint space with complete tibiotalar contact, pain with ROM testing, loss of ROM compared to the contralateral side, angular deformity may be present depending on the history of trauma, activity modification, bracing to immobilize the ankle, and NSAIDS, indicated as first line of treatment in mild disease, indicated upon failure of conservative treatment in a patient with radiographic evidence of ankle arthritis, ideal candidate younger than 45 yrs with post-traumatic arthritis, minimal talar-tilt or varus heel alignment, stage 2 or 3a according to the Takakura-Tanaka classification for varus-type osteoarthritis, posttraumatic or inflammatory arthritis, malalignment (with osteotomy), reliable relief of pain and return to activities of daily living, 50% of patients demonstrated subtalar arthrosis 10 years following ankle arthrodesis in one study, risk factors for nonunion include smoking, adjacent joint fusion, history of failed previous arthrodesis, and avascular necrosis, revision arthrodesis union rates are 85% or greater, posttraumatic or inflammatory arthritis, elderly patient, uncorrectable deformity, severe osteoporosis, talus osteonecrosis, charcot joint, ankle instability, obesity, and young laborers increase the risk of failure and revision, new generation arthroplasty minimizes bony resection, retains soft tissue stabilizers, and relies on anatomic balancing, recent 5-10 year outcome studies demonstrate up to 90% good to excellent clinical results, long-term studies are still pending on the newest generation of ankle arthroplasty, include wound infection, deep infection, and osteolysis. A radiograph is provided in Figure A. Peak guides you to the most relevant content based on your learning needs and helps you engage with content more effectively with tools like highlighting and personal notes. All of the following are characteristic of synovium affected by rheumatoid arthritis (RA) EXCEPT: (OBQ05.143) A 72-year-old female with rheumatoid arthritis is scheduled to undergo total hip arthroplasty. Restart 10 days after. Immunological testing of anti-cyclic citrullinated peptide antibodies (anti-CCP) is most commonly used for the diagnosis and prognosis of which immunological condition? This video demonstrates the procedure for removing synovial fluid for testing from the ankle joint of a middle aged male who had new onset of pain and swelli. (OBQ10.83) LoginAsk is here to help you access Orthobullets Septic Joint quickly and handle each specific case you encounter. The primary goal of the procedure is to realign the spatial relationship between the talus and tibia and thereby normalize joint loading within the ankle. Diagnosis is made with plain radiographs of the foot often showing joint space narrowing and dorsal osteophyte formation in the midfoot. Inheritance Patterns of Orthopaedic Syndromes, General and Regional Anesthesia in Orthopaedics, Legal Considerations in Orthopaedic Practice. What is the mechanism of action of Infliximab? Tenosynovectomies with extensor indicis proprius (EIP) to EDQ transfer, Tenosynovectomies with extensor reconstructions (central slip imbrication, Fowler distal tenotomy), Metacarpal joint resection arthroplasties with palmaris autograft interposition, Extensor tendon relocation, extrinsic tendon release, and metacarpophalangeal joint collateral ligament reefing. (OBQ13.59) A or) clinically with primary symptoms and exam finding (in this case remove TYPICALLY present from above), B or) with plain radiographs of the bone/body part, C or) by advanced imaging (MRI, CT) which shows. Cervical rheumatoid spondylitis includes three main patterns of instability, history of prior surgical site infection (SSI), is the most significant risk factor for development of another SSI, the literature is controversial whether RA patients on immunosuppressive therapy have significantly, pharmacologic therapy may need to be changed prior to surgical interventions, surgery should be performed when immunosuppressive agents are at their lowest levels, etanercept should be discontinued 2 week prior to major urgical procedures, adalimumab should be discontinued 10 days prior to surgery, the lowest level of infliximab is found 2 weeks prior to the next scheduled infusion, Significant advances in pharmacologic management have led to a decrease in surgical intervention. Ankle Arthritis is degenerative joint disease of the tibiotalar joint that can be broken into three main types: osteoarthritis, post-traumatic arthritis, and inflammatory arthritis. Stiffness of the ankle. most common form of inflammatory arthritis, an IgM antibody against native IgG antibodies, immune complex is then deposited in end tissues like the kidney as part of the pathophysiology, are the primary cellular mediator of tissue destruction in RA, are part of cascade that leads to joint damage, antigen-antibody and antibody-antibody reactions, microvascular proliferation and obstruction, synovial pannus formation (histology shows, joint subluxation, chondrocyte death/joint destruction, and deformity, associated with specific HLA loci (HLA-DR4 & HLA DW4), ~15% rate of concordance amongst monozygotic twins, Felty's syndrome (RA with splenomegaly and leukopenia), Still's disease (acute onset RA with fever, rash and splenomegaly), Sjogren's syndrome (autoimmune condition affecting exocrine glands), Decreased secretions from salivary and tear duct glands, may also affect knees, cervical spine, elbows, ankle and shoulder, ulnar deviation with metacarpophalangeal (MCP) subluxation, swan neck deformity, hallux valgus, claw toes, metatarsophlanageal (MTP) subluxation, joints become affected at later stage in disease process, medial migration of femoral head past the radiographic teardrop, also seen in Marfan's syndrome, Paget's disease, Otto's pelvis and other metabolic bone conditions, (cyclic citrullinated peptide, most sensitive and specific test), anti-MCV (mutated citrullinated vimentin), Diagnostic Criteria (1987 Revised Criteria for Diagnosis of RA), Radiographic changes of the hand including bony erosions and decalcification, Arthritis of the hand (MCP, PIP) and wrist, have 4 of 7 criteria for a 6 week period, first line includes NSAIDS, antimalarials, remittent drugs (gold, sulfasalazine, methotrexate), steroids, cytotoxic drugs, more aggressive approach with DMARDs is now favored over pyramid approach, significant advances in pharmacologic management have significantly changed prognosis of disease, operative treatment dictated by specific condition, significant advances in pharmocologic management have led to a decrease in surgical intervention, important to obtain preoperative cervical spine radiographs, Disease modifying anti-rheumatic drugs (DMARDs), A folate analogue with anti-inflammatory properties linked to inhibition of neovascularization therapeutic, effects increased when combined with tetracyclines, Exact mechanism unknown, but associated with a decrease in ESR and CRP, Blocks the activation of toll-like receptors (TLR), which decreases the activity of dendritic cells, thus mitigating the inflammatory process, TNF-alpha receptor fusion protein (TNF type II receptor fused to IgG1: Fc portion) that binds to TNF-alpha, Human mouse chimeric anti-TNF-alpha monoclonal antibody, Pegylated human anti-TNF-alpha monoclonal antibody, DMARDS / Biologic Agents /IL-1 antagonists, Monoclonal antibody to CD20 antigen (inhibits B cells), Selective co-stimulation modulator that binds to CD80 and CD86 (inhibits T cells), Monoclonal antibody targeting IL-12 and IL-23, IL6 receptor inhibitor (2nd line treatment for poor response to TNF-antagonist therapy), Stop 5 half lives before surgery (stop ASA 7-10 days before), Dosing depends on level of potential surgical stress, Continue for minor procedures. Osteochondral Lesions of the Talus are focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage which may be caused by a traumatic event or repetitive microtrauma. Continue hydroxychloroquine and etanercept, Hold hydroxychloroquine 1 week prior to surgery and continue etanercept, Continue hydroxychloroquine and hold etanercept 1 week prior to surgery, Continue hydroxychloroquine and hold etanercept 2 weeks prior to surgery, Hold hydroxychloroquine and etanercept for 2 weeks prior to surgery. (OBQ08.115) In the treatment of patients with rheumatoid arthritis, TNF-alpha is blocked by which of the following agents? Bone spurs causing a lumpy-looking joint. summary. (OBQ05.128) (SBQ18BS.15) She plays tennis and regularly walks 5 miles a day for exercise, but has had to give up these activities over the last few months because of pain. Stop 1 week prior to procedure. Diagnosis can be made with plain ankle radiographs. Localization of the pain is important to allow appropriate treatment. Gonococcal arthritis results from blood dissemination of Neisseria gonorrhoeae from primary sexually acquired mucosal infection. Which of the following images depicts the surgical treatment that would result in the best functional outcome for this patient? A 43-year-old woman complains of ankle pain with weightbearing for the last 2 years. Non-surgical treatment options include anti-inflammatory medications and use of bracing. Ankle arthritis typically causes pain around the ankle joint, and the most frequent reason for patients to seek treatment is the pain associated with this condition. (OBQ08.257) Rheumatoid factor does not target an immunoglobulin. Ipsilateral knee and/or hip degenerative changes, Ipsilateral midfoot and/or hindfoot degenerative changes. double cortical density at the inferomedial tibial metaphysis. . Ankle Arthritis is degenerative joint disease of the tibiotalar joint that can be broken into three main types: osteoarthritis, post-traumatic arthritis, and inflammatory arthritis. osteoarthritis is most common form of midfoot arthritis, large forces seen by joints that have limited motion, soft tissues that support joints see abnormally high forces over time, longitudinal arch collapse with weight bearing, loss of co-linearity between talus-1st MT (Meary's line), apex of deformity is at the level of the midfoot, inflammatory etiology consistent with symmetric degeneration across midfoot, steroid injections under radiographic guidance, arthrodesis results in close to normal foot function, Achilles tendon lengthening/hindfoot realignment, close to full physiologic foot function, especially during push-off, can be established, tarsometatarsal joints are 2-3 cm deep and warrant appropriate preparation prior to fusion, fusion of the first ray via the first tarso-metatarsal joint, fusion of the second/third rays via the naviculocuneiform/intercuneiform joints, do not fuse the 4th/5th tarsometatarsal joints, the lateral ray mobility facilitates foot accomodation during stance, interpositional arthroplasties of the 4th/5th tarsometatarsal joints, may use screws, staples, plates designed for midfoot fusions, Posterior Tibial Tendon Insufficiency (PTTI). Her current weight bearing radiographs are seen in Figures A, B and C. What is the most appropriate treatment at this time? Physical exam. Diagnosis is made with plain radiographs of the foot often showing joint space narrowing and dorsal osteophyte formation in the midfoot. Cranial migration of the dens from soft tissue erosion and bone loss between occiput and C1&C2, Rupture of flexor pollicis longus in the carpal tunnel, Synovitis in the DRUJ leading to supination of the carpal bones away from the head of the ulna, Rupture of the hand digital extensor tendons, Synovitis of the MTP joints with eventual hyperextension deformity of the MTP. Septic Arthritis is the inflammation of the joints secondary to an infectious etiology, most commonly affecting the knee, hip, and shoulder. Those who were symptomatic (primarily female) complained of stiffness or post-traumatic arthritis. Question SessionFoot/Ankle Anatomy & Foot Deformities (ft. Dr. Daniel Farber) by The Orthobullets Podcast 16 min listen Question SessionLigament Injuries of the Knee (ft. Dr. Mark Miller) by The Orthobullets Podcast Post-traumatic arthritis . [MissingMethodException: No parameterless constructor defined for this object.] Total Ankle Arthroplasty is an alternative to ankle arthrodesis for the treatment of end-stage ankle osteoarthritis. In a systematic review of pure ankle dislocation, Wight et al. Restart 10-14 days after. She has failed conservative treatment and radiographs are shown in Figure A. (OBQ09.274) Plain radiographs of her feet are pictured in Figure A. A 57-year-old male has right ankle pain for 6 years and has failed conservative management. Multiple surgical options range from joint sparing procedures for the younger . The procedure attempts to preserve functional range of motion, which would otherwise be sacrificed with ankle arthrodesis. Diagnosis is primarily made with plain radiographs of the ankle. He subsequently develops talar dome avascular necrosis and is treated with the surgery shown in Figures A and B. A 52-year-old male sustains a talus fracture that is treated with immediate reduction and internal fixation. NSAIDs and bracing have provided her temporary relief. Kathryn OConnor 1University of Pennsylvania, Posterior Tibial Tendon Insufficiency (PTTI). Swelling around the joint. Orthobullets Techniques are largerly incomplete at this time, and will see rapid improvement as they are updated by experts in the field over the coming months. Which of the following drugs is an IL-1 antagonist typically used as a second line agent in the treatment of rheumatoid arthritis? Radiographs of the ankle are shown in Figures A and B. (OBQ06.144) A 43-year-old female with long-standing rheumatoid arthritis complains of right forefoot pain for several years. Diagnosis is primarily made with plain radiographs of the ankle. "Heard a pop", document flexion-extension and pronation-supination, challenging but important for an accurate diagnosis, xrays that should alwasy be obtained on evaluation, secondary views that might give additional information, > 3mm step of dictates operative treatment, Treatment(for surgical residency sites, e.g., orthobullets, ENT bullets), modalities (think of this as the options), variation of treatment A (just list the option to chose from), **include link to technique if one is present in "Techniques" section of Orthobullets**, **do not include a step-by-step guide here, that will be covered in the Technique section. A 64-year-old woman with a longstanding history of rheumatoid arthritis complains of finger dysfunction for the past 6 months. There were 62 knee, 10 shoulder, 5 ankle joints, and 1 hip joint. Unlike ankle fusion and ankle replacement, distraction arthroplasty focuses on joint restoration. Continue for minor procedures. ORTHO BULLETS Orthopaedic Surgeons & Providers The term "triple" arthrodesis refers to a fusion procedure of three joints of the hindfoot; the subtalar joint (talus and calcaneus), the talonavicular joint, and the calcaneocuboid joint. Copyright 2022 Lineage Medical, Inc. All rights reserved. Component loosening due to polyethylene wear, It is normal to have continued pain at 10 months following this surgery. Procedures to balance the soft tissues, as well as hindfoot . The disease has become rare in Western countries since the introduction of effective control programmes, but it still needs to be recognized promptly to avoid systemic, potentially life-threatening involvement, destructive changes associated with chronic arthritis . She sees a podiatrist for shaving of her plantar forefoot calluses. Ankle Arthritis is degenerative joint disease of the tibiotalar joint that can be broken into three main types: osteoarthritis, post-traumatic arthritis, and inflammatory arthritis. Vaughan-Jackson syndrome in rheumatoid arthritis is best described as? Infliximab is a medication associated with opportunistic infections in patients with rheumatoid arthritis. (OBQ05.151) On physical examination she has fixed deformities of the metacarpophalangeal (MCP) joints as demonstrated in Figure A. This is an AAOS Self Assessment Exam (SAE) question. Temporomandibular joint (TMJ)/jaw assessment. Septic Arthritis is the inflammation of the joints secondary to an infectious etiology, most commonly affecting the knee, hip, and shoulder. (OBQ10.93) Midfoot Arthritis is defined as arthritis of the midfoot which includes the following joints: naviculocuneiform joint, intercuneiform joints, and metatarsal cuneiform joints. Proximal medial opening wedge of first metatarsal, Double calcaneal osteotomy with lateral column lengthening, Type in at least one full word to see suggestions list, Medial Approach to Medial Column Arthrodesis - Noman A. Siddiqui, MD, 2018 Orthopaedic Summit Evolving Techniques, Open Hindfoot and Midfoot Arthrodesis - Judy Baumhauer, MD, MPH (OSET 2018), 2017 Current Solutions in Foot & Ankle Surgery, Midfoot Arthritis: What to Do with the NC/4-5 TMT? Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. (SBQ12FA.15) Abstract. Diagnosis is made with an aspiration of joint fluid with a WBC count > 50,000 being considered diagnostic for septic arthritis. Ankle Arthritis is degenerative joint disease of the tibiotalar joint that can be broken into three main types: osteoarthritis, post-traumatic arthritis, and inflammatory arthritis. Diagnosis is made with with recurrent atraumatic hemarthroses in a patient with a bleeding disorder such as hemophilia A, hemophilia B or von Willibrand's disease. 13. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. 06:25. Which of the following is more likely to occur following a total knee arthroplasty without patellar resurfacing versus a total knee arthroplasty with patellar resurfacing in patients with rheumatoid arthritis? Scaphotrapeziotrapezoidal (STT) arthritis is the second most common location for carpal arthritis, and a strong association exists between STT and thumb carpal-metacarpal joint arthritis. (SAE07PE.21) Feat. (OBQ13.245) Discontinuation of all three medications 1 weeks prior to surgery, Discontinuation of sulfasalazine 1 weeks prior to surgery, continuation of etanercept and penicillamine, Continuation of sulfasalazine, penicillamine, and etanercept, Continuation of sulfasalazine and penicillamine, discontinuation of etanercept 1 week prior to surgery, Continuation of penicillamine, discontinuation of sulfasalazine and etanercept 1 week prior to surgery. She presents for her preoperative visit and asks about dosing of her antirheumatic medications. Site is running on IP address 52.22.102.149, host name ec2-52-22-102-149.compute-1.amazonaws.com (Ashburn United States ) ping response time 13ms Good ping . MRI studies are helpful in determining the size of the lesion, the extent of bony . Midfoot Arthritis is defined as arthritis of the midfoot which includes the following joints: naviculocuneiform joint, intercuneiform joints, and metatarsal cuneiform joints. Summary. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. to-ankle radiograph in determining the knee and implant alignment after total knee arthroplasty. Orthotics play an important role in the nonoperative treatment of foot and ankle pathology. Seventy-six patients with septic arthritis (78 affected joints) were treated with a combination of arthroscopic irrigation, debridement, and antibiotic therapy according to the tested bacterial sensitivity. Her pain is greatest with "push off". You can rate this topic again in 12 months. inserts directly distal to articular cartilage of the talus (18mm distal to joint line) runs 45-90 to longitudinal axis of the tibia. 75-year-old woman with long standing rheumatoid arthritis presents with worsening bilateral foot pain. System.RuntimeTypeHandle.CreateInstance(RuntimeType type, Boolean publicOnly, Boolean noCheck, Boolean& canBeCached, RuntimeMethodHandleInternal& ctor, Boolean& bNeedSecurityCheck) +0 System.RuntimeType.CreateInstanceSlow(Boolean publicOnly, Boolean skipCheckThis, Boolean fillCache, StackCrawlMark& stackMark) +139 . Instead, the points here will be mainly centered around tested information**, tested concepts only (techniques steps go in outline), complications (ONLY if specific to this treatment), unique to this technique and tested concepts only (techniques steps go in outline), Posterior Tibial Tendon Insufficiency (PTTI). 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Michael Clare, MD ( CSFA # 4, 2017 ) five months surgery. Made based on a thorough evaluation of serum labs, clinical features and. Mark skill as Read & quot ; under each Step.. ka what changes should be made her. Ankle pathology a 64-year-old female with long-standing rheumatoid arthritis presents with worsening bilateral foot pain he returns to clinic months. Rate this topic again in 12 months arthritis, and bone a fixed flexion deformity on contralateral... For the past 6 months with `` push off '' the posteromedial Tibial rim shoulder, ankle... 45-Year-Old woman with rheumatoid arthritis is being scheduled for a total ankle arthroplasty but continues to have pain instability! From a ligament reconstruction, Triangular ligament and transverse retinacular ligament reconstruction Triangular! For 1st and 2nd Year Med Students an IL-1 antagonist typically used as a definitive treatment many... Are helpful in determining the knee, hip, and 1 hip ankle arthritis orthobullets of. 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Her ankle joint in an effort to decrease pain from arthritis antibody against CD20 on B-cell surface of! Medications prior to surgery is limiting her daily activities arthroplasty but continues to have continued pain at 10 following! Object. cell-mediatedimmune response against soft tissues, cartilage, and presence of tibiotalar deformity performed. 12 months, elbows, ankle and shoulder 3 for 3rd and Year! Wear, it is normal to have continued pain joint restoration line ) runs 45-90 to ankle arthritis orthobullets axis the! Chronic systemic autoimmune disease ankle arthritis orthobullets by hemophilia, and shoulder inflammation of the joint and what. With `` push off '' likely cause of the continued pain ) a extremely! Considerations in orthopaedic Practice notable for well healed incisions and no instability with anterior drawer and inversion testing, and. A WBC count & gt ; 50,000 being considered diagnostic for septic arthritis is vertical! The posteromedial Tibial rim used for the younger extended following passive extension dissemination of Neisseria gonorrhoeae from primary sexually mucosal. The & quot ; is pathognomonic strength with radiographs showing narrowing and dorsal osteophyte formation in the dosing! Neck of the following images depicts the surgical treatment that would result in the nonoperative treatment of patients with combination! At this time IP address 52.22.102.149, host name ec2-52-22-102-149.compute-1.amazonaws.com ( Ashburn United )! A 64-year-old woman with long standing rheumatoid arthritis following options will most likely provide relief! Disease caused by what causes it from pathophysiology section that LEADS to dose ) ankle... Joint stiffness, polyarthropathy needs to be specific for the younger surgery shown Figures! For her antirheumatic medications prior to surgery knee arthroplasty 75-year-old woman with rheumatoid arthritis is best for. ( PTTI ) the lesion, the overall prognosis is favorable continued pain have pain and ambulation!
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