taro 2015 - corrigido e comentado

8/18/2019 Taro 2015 - Corrigido e Comentado

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Universidade Federal do Amazonas

Hospital Universitário Getúlio Vargas

Serviço de Ortopedia e Traumatologia

TARO 2015 – GABARITO BASEADO NAS REFERÊNCIAS

Pesquisado por:

José Henrique, Rafael Chang, Sandokan Costa, Érico Melo, Heyder Cabral,Talita Oliveira, Gustavo Oliveira, Eduardo Ditzel, Luis Fernando Tupinambá,Marcelo Gomes, Jaime Menezes e Luiz Felipe Tupinambá

1) A fratura da cavidade glenóide que envolve seu terço superior e inclui oprocesso coracóide é classificada segundo IDEBERG como tipo:

C) III

Fonte: Rockwood and Green’s fractures in Adults 7th ed. 1155 pg.

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2) A Leucomalácia periventricular é a lesão característica da:

A) Diplegia

Fonte: Lovell and Winter ’s Pediatric Orthopaedics 6th ed. 554 pg.


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3) A artropatia neuropática do ombro está relacionada a:

C) Siringomielia cervical

Fonte: Canale & Beaty: Campbell’s Operative Orthopaedics 11th 1045 pg.

_________________________________________________________________4) A síndrome medular central ocorre em idosos por mecanismo de:

B) Hiperextensão, e cursa com tetraparesia que afeta mais os membrossuperiores

Canale & Beaty: Campbell’s Operative Orthopaedics 12th 1572 pg.

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5) Nas lesões irreparáveis do manguito rotador envolvendo os tendõessupraespinhal e infraespinhal, a transferência muscular quando indicada é feita com o:

B) Grande Dorsal


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6) Na luxação glenoumeral anterior, a lesão do ligamento glenoumeralinferior ocorre na(s):

C) inserção gleinodal


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7) A dor lombar aguda, após exclusão de sinais de alarme, deve ser tratadacom:

D) Respouso no leito por 1 a 3 dias e progressão para programa de

exercícios físicos


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8) Na mão torta radial, a estabilização do punho utilizando os flexoressuperficiais deve incluir preferencialmente os tendões dos dedos:

A) Médio e anular


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9- O cisto ósseo simples geralmente é detectado quando o paciente

apresenta.B) Fratura patológica

Unicameral Bone CystsUBCs are not always unicameral. They are also called simple bone cysts, but theymay not be simple to treat. These common lesions are usually found when the

patient sustains a pathologic fracture. Their radiographic appearance is so typicalthat most can be diagnosed without a biopsy (Fig. 14.26). The proximal humerusand the proximal femur are the sites that account for 90% of UBCs (383, 384,

385, 386, 387).Fonte: Lovell and Winter ’s Pediatric Orthopaedics 6 th ed. Página 526

10-A metastase óssea distal ao joelho ou ao cotovelo geralmente é decorrentede carcinoma

C) pulmão

The radiographic appearance of metastatic carcinoma varies. The appearanceusually is aggressive, suggesting malignancy. The lesions may be lytic, blastic,or mixed. Breast cancer and prostate cancer typically produce blastic lesions.Kidney cancer and thyroid cancer usually are purely lytic. Lung cancer may

produce a mixed appearance. If the lesion is distal to the elbow or knee, lungcancer is the most likely primary lesion. Additionally, metastatic lung cancermay have the distinct appearance of a “ bite” taken out of the cortex.

Fonte:Canale & Beaty: Campbell’s Operative Orthopaedics 11th ed. Pagina 923

11- O fibroma ossificante localiza-se mais comumente.

A) na tíbia

Osteofibrous DysplasiaKempson (349) described the osteofibrous dysplasia lesion, which is found in themandible and the anterior cortex of the tibia in children. It is benign, but may belocally aggressive. It is not a healing NOF. The patients usually do not havesymptoms, and are brought to the physician's attention by a parent who hasnoticed an anterior bowing or mass in the tibia. The lesion is almost always

located within the anterior cortex of the tibia, and is best seen on the lateralradiograph (Fig. 14.22). There are often numerous radiolucent lesions with a rim


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of reactive bone. On the technetium-99 bone scan, there is increased uptake inthe area of the lesion.

Fonte: Lovell and Winter ’s Pediatric Orthopaedics 6 th ed. Página 521 ________________________________________________________________

12- Durante a puberdade o crescimento do tronco

C) é mais acentuado que o crescimento dos membros inferiores.

PubertyDuring puberty (from 11 to 15 years in girls and from 13 to 17 years in boys)there is a dramatic increase in the growth rate. However, during this period, thegrowth is far more noticeable in the trunk than in the lower limbs: two thirds ofthe growth goes toward increasing sitting height and only one third is toward

increasing subischial leg length.

Fonte: Lovell and Winter ’s Pediatric Orthopaedics 6 th ed. Página 45

13-A fratura osteocondral do tálus na criança é mais comum na região

A) Medial

FRACTURES OF THE OSTEOCHONDRAL SURFACE OF THE TALUSDamage to the osteochondral surface of the talus can be caused by direct trauma

or may be due to an underlying osteochondal lesion (osteochondritis dissecans[OCD]) that may have been present for some time and has been madesymptomatic by the injury. The pathogenesis and etiology of OCD iscontroversial; however, most authors report preceding trauma as a cause of thedefects (Canale and Bedding25 80%, Letts et al.91 79%, Higuera et al.65 63%, andPerumal et al.123 47%). The medialP.1026lesion is usually deeper and cup shaped compared to the thinner โ €œwafer โ €• type lateral lesion. The lateral lesion is more often associated with trauma andmore symptomatic than the medial lesions. It is postulated that the medial lesions

may be due to more repetitive microtrauma.25,26 Berndt and Harty,12 in 1959,used freshly amputated legs to biomechanically reproduce injuries to the ankleand observe the injuries inflicted. They showed that the anterolateral talus hitsthe medial aspect of the fibula with dorsiflexion and inversion and that

plantarflexion and inversion caused posteromedial osteochondral lesions (Fig.27-10).

Fonte: Rockwood and Wilkins Fractures in Children, 7th ed. Pagina 1026

14-A fratura de estresse no pé da criança gerlmente ocorre

A) no colo do segundo metatarsal


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STRESS FRACTURES The second metatarsal is the most common bone in the foot to get a stressfracture. This usually occurs at the neck of the metatarsal at the junction of themobile shaft and rigid metaphysis. Treatment involves rest and partial weight

bearing in a moonboot for 4-6 weeks.Fonte: Rockwood and Wilkins Fractures in Children, 7th ed. Pagina 1054

15- A artralgia associada à picada do carrapato geralmente é observada no

b) joelho

Lyme Disease Musculoskeletal symptoms include lower extremity cramping and a

predisposition for a proximal lower extremity myositis. There may be amonarticular or migratory inflammatory arthritic presentation. Although theknee is most commonly involved, arthralgia in other joints (e.g., shoulder andwrist) frequently occurs and can recur later or become chronic. A chronicsynovitis has been described with pannus formation.

16- O raquitismo induzido por medicamentos está relacionadoprincipalmente ao uso de

b) anticonvulsivantes

DRUG-INDUCED RICKETS Certain antiepileptic medications have been known to produce rachitic changesin children.[16,110,348] Seizure medications that affect the liver may induce the P-450 microsomal enzyme system and decrease levels of vitamin D. Hypocalcemiadevelops, which can aggravate the seizure disorder. Treatment with vitamin D isvery helpful. The condition should be suspected in neurologic patients withseizures who begin sustaining frequent fractures.[280,281]

Fonte: Herring: tachdjian's pediatric_orthopaedics 4th edition. Pag 1921 _________________________________________________________________

17. A lesão de MONTEGGIA com fratura do terço médio ou proximal daulna e fratura-luxação posterior da cabeça do rádio, é classificada porBADO como tipo:

d) 4

Bado suggested classification into four types (Fig. 57-81): type 1, fracture of the

middle or proximal third of the ulna with anterior dislocation of the radial headand characteristic apex anterior angulation of the ulna; type 2, fracture of the

http://www.expertconsultbook.com/expertconsult/p/linkTo?type=bookPage&isbn=9781416022213&eid=4-u1.0-B978-1-4160-2221-3..50036-0--bib16&appID=NGEhttp://www.expertconsultbook.com/expertconsult/p/linkTo?type=bookPage&isbn=9781416022213&eid=4-u1.0-B978-1-4160-2221-3..50036-0--bib16&appID=NGEhttp://www.expertconsultbook.com/expertconsult/p/linkTo?type=bookPage&isbn=9781416022213&eid=4-u1.0-B978-1-4160-2221-3..50036-0--bib16&appID=NGEhttp://www.expertconsultbook.com/expertconsult/p/linkTo?type=bookPage&isbn=9781416022213&eid=4-u1.0-B978-1-4160-2221-3..50036-0--bib280&appID=NGEhttp://www.expertconsultbook.com/expertconsult/p/linkTo?type=bookPage&isbn=9781416022213&eid=4-u1.0-B978-1-4160-2221-3..50036-0--bib280&appID=NGEhttp://www.expertconsultbook.com/expertconsult/p/linkTo?type=bookPage&isbn=9781416022213&eid=4-u1.0-B978-1-4160-2221-3..50036-0--bib280&appID=NGEhttp://www.expertconsultbook.com/expertconsult/p/linkTo?type=bookPage&isbn=9781416022213&eid=4-u1.0-B978-1-4160-2221-3..50036-0--bib280&appID=NGEhttp://www.expertconsultbook.com/expertconsult/p/linkTo?type=bookPage&isbn=9781416022213&eid=4-u1.0-B978-1-4160-2221-3..50036-0--bib16&appID=NGE


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middle or proximal third of the ulna (the apex usually is posteriorly angulated)with posterior dislocation of the radial head and often a fracture of the radialhead; type 3, fracture of the ulna just distal to the coronoid process with lateraldislocation of the radial head; and type 4, fracture of the proximal or middlethird of the ulna, anterior dislocation of the radial head, and fracture of theproximal third of the radius below the bicipital tuberosity.

Fonte: Canale e Beaty: Campbell’s Operative Orthopaedics 12th ed. 2886pg _________________________________________________________________

18. Na deformidade em botoeira, a imobilização para o tratamentoconservador deve manter a IFP em extensão e a IFD:

a) livre

Buttonhole deformities that are diagnosed early in closed wounds before fixedcontractures occur can be treated conservatively. If the patient can show someactive extension of the proximal interphalangeal joint, this suggests that anincompletely ruptured central slip may be present. Conservative treatmentconsists of splinting the proximal interphalangeal joint in full extension whilepermitting the distal interphalangeal joint to be actively flexed.

Fonte: Fonte: Canale e Beaty: Campbell’s Operative Orthopaedics 12th ed.3294pg

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19. A capsulite adesiva do ombro tem maior incidência em:

b) mulheres com mais de 50 anos.

The incidence of frozen shoulder in the general population is approximately 2%, but several conditions are associated with an increased incidence, including

female gender, age older than 49 years, diabetes mellitus (five times more),cervical disc disease, prolonged immobilization, hyperthyroidism, stroke or


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myocardial infarction, the presence of autoimmune diseases, and trauma.Individuals between ages 40 and 70 are more commonly affected.


20. Na lesão do anel pélvico, as artérias do sistema ilíaco interno maisrelacionadas à hemorragia são a glútea:

b) superior e a pudenda.

Arterial bleeding usually arises from branches of the internal iliac system, withthe superior gluteal and pudendal arteries being the most commonly identifiedsource.

Fonte: Rockwood and Green’s fractures in adults 7th ed, p1419 _________________________________________________________________

21. No estágio II da insuficiência do tendão do tibial posterior, classificadapor JOHNSON e STROM, encontramos no exame físico:

c) compensação para inversão do pé utilizando o tibial anterior.

Classification systems in general are useful only to the extent that they assist in planning treatment or in predicting the outcome of the condition. The

classification system originally developed by Johnson and Strom in 1989 isuseful in the management of posterior tibial tendon insufficiency. Stage I diseaseis characterized by swelling, pain, inflammation, and often effusion within the

posterior tibial tendon sheath. Irritability is noted with passive eversion of thefoot along the course of the posterior tibial tendon. Mild weakness to manualtesting may be present; however, no deformity of the foot is demonstrated whencompared with the opposite foot. The patient is able to invert the foot actively ona double-leg toe raise test and is able to perform a single-leg toe raise asdescribed in the next section. Stage II disease is characterized by the loss offunction of the posterior tibial tendon and inability to perform a single-leg

toe raise. There is attempted compensation by use of the anterior tibialmuscle and tendon unit as an accessory inverter of the hindfoot. In stage IIdisease the hindfoot remains flexible. With the hindfoot in neutral the forefootcan be brought into neutral. Generally, mild lateral or sinus tarsi impingement

pain is present. Instage III disease function of the posterior tibial tendon is lost. A fixed hindfootdeformity with valgus abduction occurs and degenerative changes may beapparent on radiographs. Significant lateral sinus tarsi pain is present. Stage IVdisease was described by Myerson et al. and involves valgus positioning andincongruency of the ankle joint in addition to stage III findings.

Fonte: Canale e Beaty: Campbell’s Operative Orthopaedics 12th ed. 3908pg


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22. Na fratura do antebraço da criança que ocorre por mecanismo indireto,os segmentos mais vulneráveis ao trauma no rádio e na ulna são,respectivamente:

a) transição médio-distal e diáfise

The primary mechanism of injury associated with radial and ulnar shaft fracturesis a fall on an outstretched hand that transmits indirect force to the bones of theforearm.3,70,165 Biomechanic studies have suggested that the junction of themiddle and distal thirds of the radius and a substantial portion of the shaftof the ulna have an increased vulnerability to fracture.

Fonte: Rockwood and Wilkins’s fractures in children 7th ed p350

_________________________________________________________________23. Na pseudartrose após osteossíntese intramedular, o exame de imagemcom maior sensibilidade para o diagnóstico é a:

d) tomografia computadorizada

Não consegui a fonte original citada pelo TARO, mas achei este artigo quecita a TC com 100% de sensibilidade.

Computed tomography scans displayed very good diagnostic accuracy.Intraobserver agreement was high (intraclass correlation coefficient = 0.89), thesensitivity for detecting nonunion was 100%, and the overall accuracy was89.9%. Computed tomography was limited by a low specificity of 62%, as three

patients who were diagnosed as having tibial nonunion with computedtomography underwent surgery and were found to have a healed fracture.

Fonte: The accuracy of computed tomography for the diagnosis of tibialnonunion. J Bone Joint Surg Am. 2006 Apr;88(4):692-7.

Em: http://www.ncbi.nlm.nih.gov/pubmed/16595457

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24. A síndrome de REITER caracteriza-se por conjuntivite, uretrite esinovite:

d) assimétrica no homem

Reiter syndrome is described as a triad of conjunctivitis, urethritis, and synovitis.The synovitis usually involves asymmetrically four or fewer joints. Heel pain,

back pain, and nail deformities may occur in this syndrome, sometimes making itdifficult to distinguish it from psoriatic arthritis. It affects the lower extremity

http://www.ncbi.nlm.nih.gov/pubmed/16595457http://www.ncbi.nlm.nih.gov/pubmed/16595457http://www.ncbi.nlm.nih.gov/pubmed/16595457http://www.ncbi.nlm.nih.gov/pubmed/16595457http://www.ncbi.nlm.nih.gov/pubmed/16595457http://www.ncbi.nlm.nih.gov/pubmed/16595457http://www.ncbi.nlm.nih.gov/pubmed/16595457


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more often than the upper, and 90% of patients have remission of symptoms afterseveral weeks; in about 10% the disease may become chronic. It is typicallyfound in young men. Surgery rarely is indicated.


25. Na fratura diafisária do f êmur, a fixação interna com placa pela viaaberta está mais bem indicada na presença de:

d) fratura ipsilateral do colo do fêmur

Fonte: Rockwood and Green’s fractures in adults 7th ed, p1668

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26. A fratura do colo do fêmur mais frequente na criança, segundo aclassificação de DELBET & COLONNA, corresponde ao tipo:

b) II

Type II Transcervical fractures are the most common fracture type (45% to50% of all femoral neck fractures),50 occur between the physis and are above the


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intertrochanteric line, and by definition are consider intracapsular femoral neckfractures.Fonte: Rockwood and Wilkins’s fractures in children 7th ed p772

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27. O granuloma eosinofílico em apresentação isolada é encontrado maisfrequentemente:

a) no crânio e no fêmur

About two thirds of cases are diagnosed in individuals younger than 20 years ofage, with most diagnoses made in the 5- to 10-year-old age group. The firstsymptom is localizing pain, occasionally accompanied by swelling and low-grade fever. The erythrocyte sedimentation rate may be elevated. The skull is

the most common site of involvement, followed by the femur. Approximately40% of solitary eosinophilic granulomas are found at one of these two sites, andthe skull and femur are also most commonly affected in cases with multiplelesions.

Fonte: Herring: Tachdjian’s Pediatric Orthopaedics 4th ed, 227pg

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28. No mecanismo da luxação anterior traumática do quadril, o membroinferior está posicionado em rotação:

d) lateral e abdução

Anterior dislocations of the hip are uncommon and, according to Epstein,constitute only 12% of traumatic hip dislocations. They occur with the hipexternally rotated and abducted.


29) Na ruptura fechada do tendão calcâneo, o mecanismo de lesão maiscomum envolve:

D) Flexão dorsal do pé com o joelho em extensão.

“Most commonly, the mechanisms of Achilles tendon rupture are pushing offwith the weight-bearing forefoot while extending the knee, sudden unexpecteddorsiflexion of the ankle, and violent dorsiflexion of the plantar flexed foot, as ina fall from a height. Disruption also can occur from a direct blow to thecontracted tendon or from a laceration.”

Fonte: Campbell 12th, pg 2321


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30) Na mielomeningocele, as fraturas ocorrem frequentemente naextremidade:

A) Distal do fêmur

“Patients with myelomeningocele are susceptible to pathologic fractures of thelower extremities, particularly in the supracondylar femoral and supramalleolartibial regions. Risk factors include inattention toward insensate parts by the

patient or caretakers, joint contracture, postsurgical cast immobilization, andhigher levels of paralysis.”

Fonte: Tachdjian 5th. pg e136 (1906 do pdf)

31) A Fratura da Clavícula classificada segundo ROBINSON como 3A2corresponde ao tipo:

C) III de Neer

Fonte: Rockwood adulto 8th pg. 1438

32) A fratura de extremidade mais sugestiva de abuso infantil é a:

A) Do canto

The almost pathognomonic fracture of child abuse is the CML (ClassicMetaphyseal Lesion), commonly termed the “corner ” or “ bucket-handle

fracture.”


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Fonte: Rockwood criança 8th. pg 248

33) Na avaliação radiográfica do acetábulo, a dissociação entre a linhailioisquiática e gota de lágrima de Kohler sugerem fratura:

D) Da superfície quadrilátera.

“Dissociation of the teardrop and the ilioischial line indicates either rotation ofthe hemipelvis, or a fractureof the quadrilateral surface.” Anteroposterior (AP)

radiograph of the pelvis.1, iliopectineal line; 2,ilioischial line; 3, teardrop;4, acetabular roof;5, anterior rim of theacetabulum; 6, posterior rimof the acetabulum.

Fonte: Rockwood adulto 8th. pg. 1900

34) A ruptura do tendão do quadríceps é mais comumente associada a:

A) Uremia, diabetes e hiperparatireoidismo

“Quadriceps rupture is more common in older patients and in patients withsystemic disease or degenerative changes. Systemic diseases, such as lupuserythematosus, diabetes, gout, hyperparathyroidism, uremia, and obesity, have

been associated with disruption of the quadriceps mechanism. A relationship between prior steroid injection, as well as use of corticosteroids orfluoroquinolone antibiotics, and tendon rupture has been documented.

Fonte: Campbell 12th. pg. 2336-2337.


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35) Na rigidez pós-traumática da articulação metacarpofalângica, acapsulotomia é contraindicada se o arco de movimento alcançar:

D) 60º

“METACARPOPHALANGEAL JOINTCAPSULOTOMY: When metacarpophalangeal joint motion is 60 degrees,capsulotomy is contraindicated because only 60 to 70 degrees of motion usuallycan be expected after surgery even if the soft tissues around the joint are normal.”

Fonte: Campbell 12th. pg 3361 (quadro azul)

36) Na luxação da aticulação acrômio-clavicular do tipo III de Rockwood,existe integridade dos ligamentos coracoclaviculares quando há fratura:

D) do processo coracoide

“Rarely, complete AC dislocation will be accompanied by a fracture of thecoracoid process rather than by disruption of the CC ligaments. Although thefracture of the coracoid process is difficult to visualize on routine radiographs, its

presence should be suspected because of the presence of a complete ACseparation and a normal CC distance, as compared with the uninjured shoulder.The ideal radiograph for visualizing the coracoid fracture is the Stryker notch

view.”

Fonte: Rockwood adulto 8th. pg. 1585

37 - Na confecção da banda de tensão para tratamento da fratura deolécrano, a colocação dos fios de KIRSCHNER em posição muito lateral estarelacionada com:

C) Impacto na Tuberosidade bicipital

Potential Pitfalls and Preventative Measures. Ten- sion-band wiring can besuccessful in properly selected patients. To avoid loss of fixation, an anatomicreduction is necessary and this technique should be used only in simple fracture

pat- terns. Hardware prominence requiring removal is common. To decrease theincidence of symptomatic hardware, the K-wires should be buried under thetriceps and the cerclage wire knots should be buried as well. If the wires are lefttoo prominent on the anteromedial aspect of the ulna, median and ulnar nerveinjury is possible. Avoid wires that exit laterally in the region of the bicepstuberosity to prevent impingement or heterotopic ossification and

subsequent synostosis.


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Fonte:Rockwood and Green’sFractures in Aduldts 8 th ed.1218 pg.

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38 - O condrossarcoma primário tem seu pico de incidência na faixa etáriaentre:

C) 40 e 60 anos

Chondrosarcoma constitutes about 9% of primary malignan- cies of bone, anincidence about half that of osteosarcoma. It is the second most commonnonhematologic primary malignancy of bone. It occurs over a broad age range,with peaks between 40 and 60 years for primary chondrosarcoma and

between 25 and 45 years for secondary chondrosarcoma.

Fonte: Canale e Bealty: Campbell’s Operative Orthopedics 12th. 914 pg.

39) No exame físico da mão, se a articulação interfalângica proximal nãoflexiona passivamente com a metacarpofalângica em extensão e flexionapassivamente com a metacarpofalângica em flexão, deve-se pensar em:

C) Retração dos músculos intrínsecos.

“The proper surgical release of established intrinsic muscle contractures dependson the severity of the contractures. When the contractures are mild (Fig. 74-9),

the metacarpophalangeal joints can be passively extended completely, but whilethey are held extended, the proximal interphalangeal joints cannot be flexed(positive intrinsic tightness test).”

Fonte: Campbell 12th . pg 3620

40) Na fratura do colo do fêmur do idoso tratada com redução anatômica efixação interna, o fator mais frequentemente relacionado à reoperação é a:

B) falha de osteossíntese


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“Although AVN (avascular necrosis of neck) is a well-recognized complication,the majority of reoperations are performed for early fixation failure inosteoporotic bone and nonunion.”

Fonte: Rockwood adulto 8th. pg. 2047.

41) Na artrogripose, a cirurgia de STEINDLER tem como objetivo acorreção da deformidade em:

D) extensão do cotovelo.

“Procedures to Achieve Active Elbow Flexion: Steindler Flexorplasty. TheSteindler flexorplasty produces elbow flexion by transferring the flexor pronatororigin from the medial epicondyle to the anterior humerus. It may be useful if themuscle can be isolated preoperatively and the wrist can be stabilized againstexcess flexion with the radial wrist extensors. Unfortunately, most children witharthrogryposis lack radial wrist extensors, and this transfer producesunacceptable wrist flexion unless these extensors are present. Thus this procedureis rarely indicated.”

Fonte: Tachdjian 5th. pg e551 (2320 do pdf)

42) A artrose do quadril secundária a OTTO PELVIS ocorre com maior

frequência em:a) Mulheres, bilateralmente.

“Intrapelvic protrusio acetabuli can be primary or secondary. The primary form,arthrokatadysis (Otto pelvis), involves both hips, occurs most often in youngerwomen, and causes pain and limitation of motion at a relatively early age.Thesecondary form can be caused by migration of an endoprosthesis, septic arthritis,or prior acetabular fracture. It can be present bilaterally in Paget disease,arachnodactyly (Marfan syndrome), rheumatoid arthritis, ankylosing spondylitis,

and osteomalacia. The radiographic hallmark of protrusion acetabuli is themedial migration of the femoral head beyond the ilioischial (Kohler) line. Thedeformity may progress until the greater trochanter impinges on the side of the

pelvis. Frequently, there is an associated varus deformity of the femoral neck.”

Fonte: Campbell 12th. Pg. 209.

43) Na fratura do escafoide, a síndrome naviculocapitato caracteriza-se por:

C) Fratura do capitato com rotação do fragmento proximal


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“NAVICULOCAPITATE FRACTURE SYNDROME AND CAPITATEFRACTURES” Although naviculocapitate fracture syndrome is rare, it should be consideredamong the associated injuries that can occur with a fracture of the scaphoid.Axial compression of a dorsiflexed wrist forces further dorsiflexion, and after thescaphoid fractures, the dorsal lip of the radius forcefully impacts the head of thecapitate, causing it to fracture. As the wrist continues into further dorsiflexion,after the scaphoid and the capitate are fractured, the capitate head rotates 90degrees. The hand, when returned to neutral position, brings the proximalfragment of the capitate into 180 degrees of rotation. This injury can beassociated with dorsal perilunate dislocation or fractures of the distal end of theradius. Open reduction is necessary to derotate the capitates fragment. Somesurgeons have excised this fragment, but others have replaced it, reduced thescaphoid and capitate fractures, and maintained them with internal fixation orcast immobilization. Osteonecrosis of the capitates may follow such injuries. Ifsufficiently symptomatic, osteonecrosis of the capitate may be treated withexcisionalinterposition arthroplasty or midcarpal or capitate-hamate arthrodesis.Isolated fractures of the capitate are unusual. Nondisplaced fractures of the bodyof the capitate are treated nonoperatively. Displaced fractures, especiallyfractures involving the joint, usually require open reduction and internal fixationwith Kirschner wires or screws.”

Fonte: Campbell 12th. pg 3417

44) A paresiados músculos biceps braquial e extensores radiais do carpo,assim como a diminuição do reflexo estilo-radial, são características da lesãoda raiz:

B) C6

Fonte: Rockwood adulto 8th. pg 1689 _______________________________________________________________


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45. Na ruptura do ligamento cruzado anterior, a largura do túnelintercondilar é menor

D) nas mulheres e interfere na ocorrência de lesão

Referência: Campbell ed 11

A number of investigators have studied the epidemiology of anterior cruciateligament – deficient knees and have implicated gender and femoral intercondylarnotch width as factors contributing to injury of the anterior cruciate ligament.

Numerous investigators have reported that athletes sustaining noncontact anteriorcruciate ligament tears have statistically significant intercondylar notch stenosis.Souryal and Freeman formulated the notch width index, which is the ratio of thewidth of the intercondylar notch to the width of the distal femur at the level ofthe popliteal groove measured on a tunnel view radiograph of the knee (Fig. 45-101). The normal intercondylar notch ratio was 0.231 ± 0.044. The intercondylarnotch width index for men was larger than that for women. They foundnoncontact anterior cruciate ligament injuries to be more frequent in athleteswho had a notch width index that was at least 1 standard deviation below themean. Shelbourne et al. studied a group of patients who had anteriorcruciate ligament reconstruction and found that women had statisticallysignificantly narrower notches than men did, but the incidence of tearing theautograft was the same between groups presumably because a notchplastyhad been performed. Data from the National College Athletic AssociationInjury Surveillance System as well as several studies have shown significantlyhigher anterior cruciate ligament injury rates in female soccer, basketball, andrugby players than in male players. Possible causative factors for the increasedincidence in women may be extrinsic (body move- ment, muscle strength, shoe-surface interface, and skill level) or intrinsic (joint laxity, hormonal influences,limb alignment, notch dimensions, and ligament size). Female sex hor- mones(i.e., estrogen, progesterone, and relaxin) fluctuate radically during the menstrualcycle and are reported to increase ligamentous laxity and to decreaseneuromuscular performance.

_________________________________________________________________

46. No pé torto congênito unilateral tratado pelo método de PONSETI, aórtese de DENIS BROWNE no pé normal deve ser utilizada com rotaçãolateral de

A) 40 graus

After removal of the last cast, a foot abduction orthosis (often called a Denis

Browne bar and shoes) is prescribed to prevent recurrence of the deformity, tofavor remodeling of the joints with the bones in proper alignment, and to increase


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leg and foot muscle strength. The orthosis consists of two straight-last open-toeshoes connected by a bar that allows the shoes to be placed at shoulder width(Fig. 23-47). The bar should hold the shoes at 70 degrees of external rotationand 5 to 10 degrees of dorsiflexion. In unilateral cases, the normal footshould be in 40 degrees of outward rotation. Maintaining the feet atshoulder width facilitates foot abduction. The orthosis is worn full time for atleast 3 to 4 months, and afterward it is worn at nap and nighttime for 2 to 4 years.

Fonte: Tachdjian 4 ed pag. 1081 _________________________________________________________________ 47. Na fratura da diáfise da tíbia, a lesão neurológica mais comum apósosteossíntese intramedular é a do nervo

D) fibular comum

A lesão neurológica mais comum após a osteossítese intramedular de umafratura tibial é a lesão do nervo fibular. Koval et al. Documentaram uma

prevalência das lesões neurológicas de aproximadamente 30% em uma revisãoretrospectiva de 60 pacientes tratados com uma haste intramedular comfresagem, mas afirmaram que, na maioria do casos, eram pequenas neuropraxiassensitivas; 89% dessas lesões foram temporárias e ficaram curadas em 3 a 6meses. No entanto, 2 pacientes em sua série continuaram a exibir deficiêncianervosa um ano depois do procedimento (nível de evidência 4).

Fonte:Rockwood 7 ed pag. 1903 _________________________________________________________________48. A ruptura da banda sargital do capuz extensor dos dedos da mão ocorremais comumente do lado

B) ulnar do dedo médio

Traumatic Dislocation of the Extensor Tendon at the Metacarpophalangeal Joint

Traumatic dislocation of the extensor tendon toward the ulnar aspect of themetacarpophalangeal joint occurs most commonly in the long finger. Thedislocation usually occurs as a result of a tear in the proximal radial portion ofthe shroud ligament (sagittal bands) and the more proximal fascia as the finger issuddenly extended against a force, as in a flicking or thumping motion. Ulnarside disruption with radial displacement of the tendon is rare. More violentmechanisms may cause collateral ligament and joint surface injury. If seen withinthe first few days, this dislocation can be treated effectively with splinting of themetacarpophalangeal joint and wrist in extension for about 3 to 4 weeks,followed by 3 to 4 weeks of removable splinting or buddy taping to the adjacent

finger on the radial side in the case of ulnar displacement. If the condition goesundetected and becomes chronic, a repair using a section of the central fibers of

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Waldenström's observation that the clinical course of the disease is variableremains true today.[351] He observed that although some children experiencedonly minor symptoms and minimal changes in the shape of the femoral head,most had a more severe course, resulting in pain while walking and greater lossof limb motion. Waldenström defined the stages of the disease as shown in Table17-1. His classification has been modified by most authors to the four stages ofinitial, fragmentation, healing (reossification), and residual phases. In aretrospective study, we found that the time from first radiographic evidence ofdisease to the start of fragmentation was a mean of 6 months (range, 1 to 14months), the fragmentation phase lasted 8 months (range, 2 to 35 months), andthe healing stage occupied 51 months (range, 2 to 122 months).[143] Clinical findings correspond to some degree with the radiographic stages of thedisease (Table 17-2). During the early stage of the disorder, radiographs showonly increased density of the femoral head, and the patient may experiencerecurrent aggravation and alleviation of symptoms and signs. There may be onlymild limp and pain for a time, interrupted by episodes of moderate discomfortlasting a couple of weeks. During the latter phase, a subchondral fracture isfrequently noted on radiographs (Salter's sign), and the patient's clinical statusmay worsen.[307]

Table 17-2 -- Association between Clinical Findings and RadiographicStages of Disease

Stage Clinical Findings Radiographic Changes

Increaseddensitystage

Limp and pain variable,often mild and intermittent

Increased density of femoralhead, with/without subchondralfracture

Fragmentation stage

Pain and limp may worsen;may lose range of motion

Head shows fragmentation, maylateralize and flatten

Reossification stage

Limp and pain graduallyresolve, range of motionimproves

Femoral head graduallyreossifies; flattening of head mayimprove

Healedstage

Occasional limp; occasionallocking, popping

May develop osteochondroticlesion

At the beginning of the fragmentation stage, the femoral head starts tocollapse and may extrude from the acetabulum. The patient's limp and painare more pronounced, and there is a greater loss of range of motion of theaffected limb. Because the femoral head is deformed, resting the hip usually doesnot return normal motion to the joint. In mild cases, where there is minimalchange in the shape of the femoral head, symptoms and signs may be limited.Patients who have a very brief fragmentation stage are asymptomatic. In moresevere cases, however, clinical symptoms and signs progressively worsen

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throughout the fragmentation phase.The beginning of the healing stage is characterized radiographically by thedevelopment of new bone in the subchondral regions of the femoral head. By thistime, pain and limp have usually started to resolve, but there is still somelimitation of motion. The degree of motion restriction is directly related to theextent of change in the shape of the femoral head. Usually the child graduallyresumes normal activities without complaints. Symptoms are normally absent asthe femoral head becomes completely reossified.If reossification in the central segment of the femoral head is significantlydelayed, the patient may begin to experience pain after a number ofasymptomatic years. A loose fragment or osteochondritis dissecans lesion maysubsequently develop in this soft portion of the head. The child complains oflocking and popping of the joint, and crepitus may be present on physicalexamination.

Fonte: Tachjian 4 ed.

_________________________________________________________________

51. Na fratura do calcâneo tratada pela via lateral estendida, a principalfonte vascular do retalho fasciocutâneo é a artéria

A) calcaneana lateral

Lateral ApproachThe original lateral approach was a standard Kocher approach.62,108,119,121,159 Thisapproach offered limited access to the body of the calcaneus, often resulted inscarring of the peroneal tendons, and frequently damaged the sural nerve. In1984, Fernandez64 first described the extensile posterolateral approach (Fig. 59-23A). In this approach, an incision was made halfway between the fibula andAchilles tendon and starting three fingerbreadths above the tip of the lateralmalleolus. This was extended around the malleolus, following the course of thesural nerve and small saphenous vein toward the fifth metatarsalP.2078

base. The sural nerve was identified and protected, and then full-thickness flapswere developed to bone. After the peroneal tendons were dislocated over the tipof the malleolus, the calcaneofibular was cut off the calcaneus and then retractedanteriorly such that the subtalar joint and sinus tarsi were exposed.Seligson described a very similar incision in a report by Gould82 that same year(Fig. 59-23B). The goal of the incision was to expose the entire lateral face of thecalcaneus to the level of the calcaneocuboid joint. This approach combines the

posterior approach for the ankle, described by Picot in 1924,162 with a unique plantar limb that undulated so that the final closure could be tension free. Theincision was made just lateral to the Achilles tendon and carried vertically to the

superior pole of the calcaneus. The incision was then curved gently following aline where the thinner skin of the lateral side of the hindfoot met the skin of the


24/48

heel pad. The incision was carried to the base of the fifth metatarsal. The authorstressed that in the gentle curved portion of the incision, the knife should betaken straight to bone with the skin, subcutaneous layer, and periosteum kept as asingle layer. The lateral flap was then developed as a single,P.2079thick flap. The peroneal tendons were subsequently elevated from the peronealtubercle and reflected dorsally, while the calcaneofibular ligament was detachedfrom the calcaneus. After subtalar capsulotomy, the entire lateral calcaneus,calcaneocuboid, and subtalar joints were exposed.Many surgeons reported problems with the sural nerve and with wound healingusing a form of the lateral approach.13,186,243 Borelli21 described the arterial bloodsupply of the subcutaneous tissues of the lateral hindfoot and defined therelationships between these arteries and the lateral extensile incision used forORIF of calcaneal fractures (Fig. 59-24). Three arteries — the lateral calcaneal,the lateral malleolar, and the lateral tarsal artery — were consistently found alongthe lateral aspect of the hindfoot. The lateral calcaneal artery appeared to beresponsible for the majority of the blood supply to the corner of the flapand, because of its proximity to the vertical portion of the typical incision, itappeared most likely to be injured from inaccurate placement of theincision. As a result of this work, and to protect the sural nerve, the authorsrecommended that the vertical limb of the incision be started just anterior to thelateral edge of the Achilles tendon and at the crease of the heel pad and lateralfoot. This study therefore supports the original description of Seligson.82 Fonte: Rockwood 7 ed

_________________________________________________________________

52. O eixo de flexo-extensão do cotovelo no plano lateral encontra-se

A) no centro da tróclea

The elbow is composed of two independent uniaxial joints. One is thehumeroulnar joint, which is a hinged, or ginglymoid, joint. The other consists ofthe humeroradial and proximal radioulnar articulations, a pivoted, or trochoid,

joint, allowing two degrees of freedom in the elbow joint. Motion in the elbow

involves rotation of the ulna around the humerus during flexion and extensionand rotation of the radius around the ulna during supination and pronation. Theinstant center of flexion and extension for the elbow is at the center of concentriccircles formed by the lateral projection of the capitellum and trochlea of the distalhumerus, is about 2 to 3 mm in diameter, and is located in the center of thetrochlea when viewed from the lateral aspect (Fig. 8-34). The axis of rotation ofthe elbow lies anterior to the humeral midline and on a line drawn along theanterior cortex of the humerus. Morrey and Chao found that the carrying anglevaried from 11 degrees of valgus with the elbow in full extension to 6 degrees ofvarus with the elbow in full flexion (Fig. 8-35). The joint surfaces slide until the

extremes of full flexion and extension are reached, and then bony impingementoccurs. The transverse axis of rotation of the radiohumeral joint coincides with


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the ulnohumeral axis. The longitudinal axis of the forearm passes through theradial head proximally and the ulnar head distally and is oblique to thelongitudinal axes of the radius and ulna. The normal range of motion of theelbow is from 0 degrees (full extension) to approximately 150 degrees (fullflexion).

_________________________________________________________________

53) Na artroplastia total do quadril displásico dos tipos 3 e 4 de Crowe, aprincipal complicaçãoo neurológica é a lesão do nervo

D) Isquiático

For Crowe type III and type IV hips, femoral length is more problematic. Whenthe prosthetic socket has been placed in the true acetabulum, the femur must be

translated distally several centimeters to reduce the prosthetic femoral head intothe acetabulum. Often the tissues most limiting this distal translation are thehamstrings and rectus femoris rather than the abductors. In such cases, a femoralshortening osteotomy allows reduction of the femoral head into the trueacetabulum without extensive soft tissue release. Osteotomy of the greatertrochanter and resection of 2 to 3 cm from the proximal femoral metaphysis may

be necessary to permit reduction of the joint without causing undue tension onthe sciatic nerve or fracture of the femoral shaft (Fig. 3-77)

Fonte: Campbell 11 th ed. Pag. 378

_________________________________________________________________

54) No punho reumatoide a lesão de Mannerfelt é relacionada a ruptura dotendão do

D) flexor longo do polegar

Although flexor tenosynovitis at the wrist may not be as apparent as that seen onthe extensor surface, the bulk of the tenosynovium interferes with finger motion,

compresses the median nerve in the carpal tunnel, and leads to tendon rupture.Erosion of the volar capsule and ligaments over radial osteophytes contribute toflexor pollicis longus rupture in the carpal tunnel (Mannerfelt lesion)

Fonte: Campbell 11 th ed 4218 _________________________________________________________________

55) As lesões musculares são mais comuns em músculos:

D) biarticulares e naqueles com predominância de fibras tipo II


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Strains most commonly occur in muscles that cross two joints, in muscles thathave a higher percentage of type II fast-twitch muscle fibers , and in theweaker muscle of an agonist-antagonist muscle group. One factor contributing tomuscle overload is fatigue, which makes the muscle unable to absorb as much

eccentric force before overload. Another factor that can lead to strain in a muscleis intrinsic tightness in the muscle, especially in muscles that cross two joints,such as the hamstrings, the rectus femoris, and the gastrocnemius.

ESTA AFIRMAÇÃO EXISTE NO CAMPBELL 11ª ed E FOI OMITIDA NOCAMPBELL 12ª edFonte: Campbell 11 th ed. 2747

_________________________________________________________________

56) Uma fratura AO 43A3 com exposição de 3cm e lesão isolada da artériatibial anterior deve ser classificada, segundo gustilo et al, como do tipo

A) II

Fonte: Rockwood 7 th ed. 288 ________________________________________________________________

57) No paciente obeso com fratura subtrocantérica de fêmur, o implantemais recomendado é:

B) haste intramedular anterógrada

Fonte: Jupter J:. Skeletal Trauma 4 th ed. 2021

_________________________________________________________________

58) Na osteogênese imperfeita classificada segundo SILENCE, a fragilidadeóssea é mais grave no tipo:

B) II


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Fonte: Tachdjian 4th. Pg 1947 _________________________________________________________________

59) Na fratura isolada da cabeça do rádio classificada por MASON comotipo II, é indicação absoluta de tratamento cirúrgico:

A) Restrição da rotação do antebraço

The indications for open reduction and internal fixation remain controversial.Clear indications include displaced, non- comminuted fractures of the radial headlimit forearm rotation, or radial head fractures fixed as a component of thesurgical repair of an elbow fracture-dislocation. It has been suggested thatfractures displaced greater than 2 mm and involving greater than 30% of thearticular surface (a Type II fracture in the modified Mason classification) might

be best treated with surgery; however, this remains unproven.

Fonte: Rockwood adulto 7th. Pg 913-914 _________________________________________________________________

60) A osteomielite hematogênica aguda do terço proximal do fêmur

apresenta maior possibilidade de evolução para osteonecrose da epífise nafaixa etária entre:


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a) 0 a 18 meses

It is important to bear in mind that continued vigilance is necessary when treatingosteoarticular infections of the large joints in this age category, particularly up to

age 18 months, when long-term sequelae from osteonecrosis and growthdisturbance may result.[16,45,115,135] For this reason, I endorse early aspiration andsurgical debridement of the hip and shoulder whenever sepsis is encountered inearly childhood.

Fonte: Canale & Beaty: Campbell's Operative Orthopaedics, 11th ed. _________________________________________________________________61 – O teste de McMURRAY para lesão meniscal do joelho é realizado:

B) de flexão para extensão, em decúbito dorsal.

The McMurray test (Fig. 43-37) is probably best known and is carried out asfollows. With the patient supine and the knee acutely and forcibly flexed, theexaminer can check the medial meniscus by palpating the posteromedialmargin of the joint with one hand while grasping the foot with the otherhand. Keeping the knee completely flexed, the leg is externally rotated as faras possible and then the knee is slowly extended. As the femur passes over atear in the meniscus, a click may be heard or felt. The lateral meniscus is checked

by palpating the posterolateral margin of the joint, internally rotating the leg asfar as possible, and slowly extending the knee while listening and feeling for a

click. A click produced by the McMurray test usually is caused by a posterior peripheral tear of the meniscus and occurs between complete flexion of the kneeand 90 degrees. Popping, which occurs with greater degrees of extension when itis definitely localized to the joint line, suggests a tear of the middle and anterior

portions of the meniscus. The position of the knee when the click occurs thusmay help locate the lesion. A McMurray click localized to the joint line isadditional evidence that the meniscus is torn; a negative result of the McMurraytest does not rule out a tear.

Fig. 43-37 McMurray test for meniscal injury (see text).(From Tria AJ Jr: Clinical examination of the knee. In Scott WN, ed: Insall & Scott surgery of the knee, 4th ed, Philadelphia, 2006, Churchill Livingstone Elsevier.)

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Canale & Beaty: Campbell´s Operative Orthopedics 11th ed. 2424 pg

62 – No cordoma sacrococcígeo, o diagnóstico radiográfico é dificultado

pela:A) presença de gás intestinal.

Radiographically, chordomas appear as destructive lesions (Fig. 22-11). Theyvirtually always arise from the midline. Sacrococcygeal lesions often are missedon the initial radiographic examination because of overlying bowel gas. Theyusually are seen more easily on a lateral view of the sacrum. Likewise,radioisotope accumulation in the bladder can obscure a sacral tumor on bonescan. More than 50% of chordomas exhibit radiographically detectablecalcification. CT may be better for detecting calcification (which may help withthe diagnosis), but MRI is better for determining the full extent of the lesion andits relationship to other anatomical structures. A common pitfall in the evaluationof a patient with a chordoma and low back pain is ordering an MRI of only thelumbar spine; this study usually misses a sacrococcygeal chordoma because mostarise below S3.


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Fig. 22-11 A and B, Anteroposterior and lateral views of sacrum of patient withsacrococcygeal chordoma. This lesion could be missed easily because ofoverlying bowel gas. C, MRI clearly shows lesion. D, Typical microscopicappearance of chordoma. Cells with abundant vacuolated cytoplasm

(physaliferous cells) are arranged in cords with mucinous background.Canale & Beaty: Campbell´s Operative Orthopedics 11th ed. 914 pg

63 – Na artroplastia total de joelho, o corte posterior dos condilos femoraisdeve ser feito com:

C) 3° de rotação lateral

Bone Preparation: Bone surface preparation is based on the following

principles: appropriate sizing of the individual components, alignment of thecomponents to restore the mechanical axis, recreation of equally balanced softtissues in flexion and extension, and optimal patellar tracking.

TECHNIQUE 6-2

• Make the distal femoral cut at a valgus angle (usually 5 to 7 degrees) perpendicular to the predetermined mechanical axis of the femur. The amount of boneremoved generally is the same as that to be replaced by the femoral component. If a

significant preoperative flexion contracture is present, remove additional bone fromthe distal femur at this time to widen the extension gap.

• The anterior and posterior femoral cuts determine the rotation of thefemoral component and the shape of the flexion gap. Excessive external rotationwidens the flexion gap medially and may result in flexion instability. Internal rotationof the femoral component can cause lateral patellar tilt or patellofemoral instability.

• Femoral component rotation can be determined by one of severalmethods. The transepicondylar axis, anteroposterior axis, posterior femoral condyles,and cut surface of the proximal tibia all can serve as reference points.

• If the transepicondylar axis is used, make the posterior femoral cut parallel to a line drawn between the medial and lateral femoral epicondyles.Determine the anteroposterior axis by drawing a line between the bottom of the sulcusof the femur and the top of the intercondylar notch, and make the posterior femoralcut perpendicular to this axis (Fig. 6-32).

• When the posterior condyles are referenced, make the cut in 3 degreesof external rotation off a line between them. A valgus knee with a hypoplastic lateralfemoral condyle may lead to an internally rotated femoral component if the posteriorcondyles alone are referenced (Fig. 6-33).


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Fig. 6-32 Alignment axes in knee with normal condylar shape. Resection perpendicular to anteroposterior axis (AP) or parallel to epicondylar axis (epi)results in resection line (x) that is slightly externally rotated relative to posteriorcondylar axis (PC). This results in correct positioning of the femoral component.(From Arima J, Whiteside LA, McCarthy DS, et al: Femoral rotational

alignment, based on the anteroposterior axis, in total knee arthroplasty in avalgus knee: a technical note, J Bone Joint Surg 77A:1331, 1995.)

Fig. 6-33 Hypoplastic lateral condyle causes relative internal rotation of posterior condylar axis

Canale & Beaty: Campbell´s Operative Orthopedics 11th ed. 265 pg

64 – No ombro, o estabilizador primário da transição ântrero-posterior dacabeça do úmero é:

D) o ligamento glenoumeral inferior.

The inferior glenohumeral ligament consists of three different components: thesuperior band, the anterior axillary pouch, and the posterior axillary pouch.197 This ligament originates from the anteroinferior aspect of the labrum and extendsto the inferior aspect of the lesser tuberosity. The inferior glenohumeral ligamentcomplex has been compared to a hammock-like swing that surrounds andsupports the humeral head when the shoulder is abducted.199 As such, this

ligament has been demonstrated to be the primary stabilizer against anterior and


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posterior translation of the humeral head, as well as being a restraint againstexcessive external rotation of the abducted shoulder.

Rockwood and Green´s fractures in Adults 7th ed. 1165-66

65 – Na fratura do processo odontóide, a fixação com parafuso é contraindicada se houver:

D) traço de fratura de ântero-inferior para póstero-superior.

Indications: Beyond the general surgical indications outlined earlier, anteriorodontoid screw fixation requires additional consideration of several factors.Concerning fracture pattern, transverse fractures or oblique fractures in which thefracture line runs from anterosuperior to posteroinferior can be stabilized by anodontoid screw. Importantly, odontoid screws are contraindicated in fracturesthat pass from anteroinferior to posterosuperior, as compression will worsenfracture displacement (Fig. 42-44). Nearly anatomical reduction is required for

odontoid screw insertion. As screw trajectory is a critical factor, screw insertionmay not be technically possible in patients with barrelshaped chests or


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pronounced cervical kyphosis. Odontoid screws are most appropriate for type IIfractures. They should not be considered for type I and most type III fractures.Some type III fractures that pass through the superior aspect of the C2 vertebral

body (closer to the odontoid waist) are amenable to screw fixation.

Rockwood and Green´s fractures in Adults 7th ed. 1350

66 – Na incidência radiográfica em perfil da escápula, a posição da cabeçado úmero em relação ao centro do Y é:

D) central.

FIGURE 38-17 Interpretation of the scapula lateral, also known as the “Y” viewradiograph. The obtained view of the scapula is projected as the letter Y. Asshown in the schematic (A), the lower limb represents the scapula body whereas


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the upper limbs represent the coracoid process and the scapular spine. Scapulalateral radiograph of a cadaveric scapula (B) highlights the fact that the glenoidsurface lies in the middle of the letter Y. Therefore in these radiographs, thehumeral head should lie directly over the glenoid in the middle of the Y (C).

Fonte: Rockwood and Green´s fractures in Adults 7th ed. 991

67 – Na displasia do desenvolvimento do quadril diagnosticada tardiamente,o obstáculo intra-articular mais significativo para a redução é:

A) a constrição da cápsula articular.

Late Diagnosis - In the late-diagnosed case, the c:maa.rticular obstacles toreduction include the contracted adductor longus and the iliopsoas. Thesemuscles are shortened because of the hip being in the subluxated or dislocated

position, allowing secondary muscle shortening. The intr.wticular obstacles toreduction in late-diagnosed DDH include the ligamenwm teres, the trans\lerseacetabular ligament, the constricted anteromedial joint capsule, and, rarely; aninverted and hypertrophied labrum (32, 120). The most significant intraarticularobstacle ro reduction, however, is some degree of anteromedial hip capsularconstriction (32, 121-125). The ligamentum teres may be thickened, and it may

become the primary obstacle to reduction in some cases. In children of walking

or crawling age, the ligamentum teres may be significandy elongated andenlarged. Its sheer bulk precludes concent.ric reduction without excision of theligament. The t.tansverse acetabular ligamenrum may hypert.tophy secondary tothe constant pull of the ligamentum teres on its attachment at the base of theacetabulum (32, 125). This efli:ctdecreases the diameter of the acetabulum.

Fonte: Lovell and Winter´s Pediatric Orthopaedics 7th ed. 991pg

68 –

A deformidade em rotação interna dos ossos da perna é

associada aopé:

B) torto congênito.

Controversy exists concerning the presence or absence of excessive medial orinternal tibial torsion. Evidence for[76,97,103] and against[27,66,154] thisdeformity has been reported, and it is our experience that true medial tibialtorsion can exist in the presence of clubfoot but is generally unusual. Moreimportant is the intra-articular (interosseous) deformity known as medial, orinternal, spin. This deformity, which involves both the talus and the calcaneuswithin the mortise, is also a source of controversy.


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Fonte: Herring: Tachdjian´s Pediatric Orthopaedics 11th ed 1103pg

69) Na fratura Toracolombar avaliada segundo a classificação de

distribuição de carga (Load Sharing Classification), a via anterior é indicadaquando o somatório de pontos é:

D) > 6

“ Other classification systems have been developed with the goal of guidingtreatment and providing prognostic information about these injuries. Afterreviewing the radiographs and CT scans of 100 thoracolumbar fractures, McAfee

et al.105

separated these injuries into six discrete groups: wedge-compression,

stable and unstable burst, Chance, flexion – distraction, and trans- lational. Withits emphasis on the mechanism by which the middle column failed, this schemewas able to determine which type of instrumentation (i.e., distraction or

compression) was most suitable for each fracture. McCormack et al.106

devisedthe “load-sharing classification,” which uses a grading system to assessvertebral body comminution, displacement of bony frag- ments, and post-traumatic kyphosis as a means of establishing which injuries may beappropriately managed with immobilization alone or short-segmenttranspedicular constructs limited to the levels immediately above and below thefracture site (Fig. 45-13). By identifying cases that were complicated by implant

breakage, the authors suggested that a point total greater than 6 required aconcomitant anterior arthrodesis with a strut graft. The load sharingclassification algorithm has since been vali- dated by both in vitro biomechanicalexperiments and other clinical series”

Fonte: RW 8ª Edição, 1768 p.

_________________________________________________________________70) A complicação nervosa mais frequente observada na lesão de Monteggiaé a lesão do:

D) Interósseo Posterior

“… no entanto, o nervo Interósseo Posterior é, de longe, o mais comumentelesionando, especialmente em associação com uma fratura-luxação deMonteggia”


_________________________________________________________________71) Na infecção vertebral, a principal via de disseminação é:

A) Hematogênica Arterial


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“ Spinal infection can occur by direct infection of the disc itself, usuallythrough surgical manipulation directly or percutaneously, or by local spread fromcontiguous structures. Contiguous spread has been reported to occur from thecolon via subphrenic abscesses and from abdominal abscess extension fromgunshot wounds without direct spinal injury. The most common method ofspinal infection is through the arterial spread of pyogenic bacteria. Thisarterially spread infection originates in the end plate of the vertebra, probably inthe venous channels, or in the vertebral body itself and spreads to the discsecondarily as the infection progresses.”

Fonte: Campbell 12ª Edição, 1967 p.

_________________________________________________________________72) Na fratura diafisária proximal do radio, o desvio do fragment superiorocorre pela ação dos músculos:

D) Supinador e Bíceps Braquial

“ Em fraturas da parte superior do radio, abaixo da inserção do supinador eacima da da inserção do pronador redondo, dois músculos robustos (biceps esupinador) exercem uma força sem obstáculo que promove a supinação dofragmento radial.”

Fonte: RW, 7ª Edição, 887 p.

_________________________________________________________________

73) A Doença de Dupuytren caracteriza-se por:

C) Acometer 10x mais os homens

“ Commonly occurring in adults in their 40s to 60s, Dupuytren contractureoccurs 10 times more frequently in men than in women.”


_________________________________________________________________

74) Na fratura da extremidade proximal do úmero, a complicação maiscomum é:

B) Rigidez Articular

“ The most common complication of proximal humeral fractures is lossof motion (stiffness). Early physical therapy is associated with improved motion,

but many patients do not recover full motion even with early physical therapy.Impinge- ment from high-riding tuberosities or subacromial scarring also canlimit motion”



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_________________________________________________________________

75) O padrão mais simples de fratura-luxação do cotovelo é:

B) Luxação Posterior com Fratura da Cabeça do Rádio“ O padrão mais simples de fratura-luxação do cotovelo é a luxação

posterior do cotovelo com fratura da cabeça do radio”


_________________________________________________________________

76) A principal complicação da artroplastia semiconstrita do cotovelo é:

B) Soltura

“ A principal complication of constrained total elbow arthroplasty has beenloosening, usually of the humeral component (Table 12-7). For semi-constrained

prostheses, loosening of the humeral component, previously the most commoncause for revision, has been reduced to less than 5% overall with improvementsin prosthesis design, changes in operative technique, and better understanding ofthe anatomy and function of the elbow.”


_________________________________________________________________


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77 – Na escoliose idiopatica do adolescente, o risco de progress dadeformidade entes da maturidade esquelética está associado com

C) Acometimento do sexo feminino

Adolescent Idiopathic ScoliosisPrevalenceThe prevalence of radiographic curves measuring at least 10 degrees ranges from1.5% to 3.0%, that of curves exceeding 20 degrees is between 0.3% and 0.5%,and that of curves exceeding 30 degrees is between 0.2% and 0.3%. A definiterelationship between idiopathic scoliosis and sex has been noted,particularly as the magnitude of the curve increases. The ratio of affectedfemales to males has been reported to be 1 : 1 for curves between 6 and 10degrees, 1.4 : 1 for curves between 11 and 20 degrees, 5.4 : 1 for curvesexceeding 21 degrees but not requiring treatment, and 7.2 : 1 for curves

requiring orthopaedic intervention. 650 This sex prevalence in idiopathicscoliosis — that is, an equal prevalence between the sexes for small curves(


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angle, or the mechanical axis have not improved early detection of infantile tibiavara,135,185 nor have radiographic measurements been helpful in establishingthe severity of disease once the condition is present. Any limb malrotationduring radiographic examination can affect the measured MDA and thetibiofemoral angle.94,212 Thus, although measurement of the MDA mayhave some prognostic accuracy,71 it has not by itself been reliable todiagnose impending infantile tibia vara.61,6

Fonte: Herring: Tachdjian`s Pediatric Orthopaedics 5th Ed. Página 714-16

79- Na fratura supracondiliana do úmero em extensão, o desvio mais comumdo fragmento distal é

D) Posterior e Medial

Extension type: Hyperextension occurs during fall onto an outstretched hand

with or without varus/valgus force. If the hand is pronated, posteromedialdisplacement occurs. If the hand is supinated, posterolateral displacement occurs.Posteromedial displacement is more common. Generally, medial displacement ofthe distal fragment is more common than lateral displacement, occurring inapproximately 75% of patients in most series.

Fonte: Rockwood and Wilkin`s fractures in Children 8th ed. Página 583


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80- A fusão do arco posterior do atlas ocorre na faixa etária entre

A) 3 a 4 anos

AtlasThe atlas ultimately comprises three ossification centers, one for each lateralmass and one for the body, which does not appear until 1 year of age. The

posterior arches fuse by approximately 3 or 4 years of age, and the lateral massesfuse to the body at the neurocentral synchondroses at age 7 years 103 (Fig. 11-1).As a result the final internal diameter of the atlas is present by approximately age7 years, whereas further growth of the external diameter of the atlas occursthrough appositional bone deposition.

Fonte: Herring: Tachdjian`s Pediatric Orthopaedics 5th Ed. Página 167

81 – O corte transversal do radio nas suas porções proximal, média e distal é respectivamente:

C- Cilíndrico, Triangular e Oval

AnatomyThe anatomy of the forearm is responsible for some of the unique features of

fractures of the forearm. Fractures are more common distally for several reasons.First, although both bones are thick-walled throughout the greater part of theirshafts, the cross section of the radius flattens distally. Proximally, it is cylindric;it becomes triangular in the midshaft and ovoid distally. This geometric change

produces a structural weakness in the radius that has been shown to fracture firstin both-bone forearm fractures.260 Second, the muscular envelope of the

proximal part of the forearm provides more protection to the underlying bonethan distally, where it becomes tendinous.

Fonte: Herring: Tachdjian`s Pediatric Orthopaedics 5th Ed. Página 1333

82 – Na síndrome do túnel radial, a compressão do nervo interósseoposterior ocorre

D) Na origem do músculo extensor radial curto do carpo

According to Spinner, posterior interosseous nerve entrapment is of two types. Inone type, all the muscles supplied by the nerve are completely paralyzed; these

include the extensor digitorum communis, extensor indicis proprius, extensordigiti quinti, extensor carpi ulnaris, abductor pollicis longus, and extensor


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pollicis brevis. In the second type, only one or a few of these muscles are paralyzed. Entrapment of the posterior interosseous nerve can cause chronic andrefractory tennis elbow. Such entrapment is called radial tunnel syndrome andcan occur at four potentially compressive anatomical structures: (1) the origin ofthe extensor carpi radialis brevis, (2) adhesions around the radial head, (3) theradial recurrent arterial fan, and (4) the arcade of Frohse as the posteriorinterosseous nerve enters the supinator

Fonte Oficial: Canale & Beaty: Campbell`s Operative Orthopaedics 11th ed Pag3981Fonte Utilizada: Canale & Beaty: Campbell`s Operative Orthopaedics 12th edPag 3100

83- Nas fraturas da metáfise proximal da tibia em crianças, a complicaçãotardia associada a interposição da pata de ganso é

c) Deformidade em Valgo

Recent studies suggest that the postfracture tibia valga is the result of an injury tothe pes anserinus tendon plate. It is suggested that the pes anserinus tethers themedial aspect of the physis, just as the fibula appears to tether the lateral aspectof the proximal tibial physis. Multiple authors believe that the proximal tibial

fracture disrupts the tendon plate, producing a loss of the tethering effect.This, then, may lead to medial physeal overgrowth and a functionalhemichondrodiastasis (physeal lengthening).6,27,29,158,164 Exploration ofthe fracture, followed by removal and repair of the infolded periosteum thatforms the foundation of the pes anserinus tendon plate, has been suggestedas an approach that may decrease the risk of a developmental valgusdeformity. This theory is supported by the work of Houghton and Rooker, whodemonstrated that division of the periosteum around the medial half of the

proximal proximal tibia in rabbits induced a valgus deformity. Theyhypothesized that the increasing valgus angulation was because of a mechanical

release of the restraints that the periosteum imposes on activity of the physis.71Fonte Oficial: Skeletal Trauma in Children 5th Página 440Fonte utilizada para a resposta: Fonte: Rockwood and Wilkin`s fractures inChildren 8th ed. Página 1141

84 – A vascularização da cabeça do femur depende predominantemente dosvasos capsulares localizados nas regiões

d) Superior e Posterior


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Injury to the vascular supply of the femoral head is an important factor in hipdislocations. In adults, the primary blood supply to the head derives from thecervical arteries. These arteries originate from the extracapsular ring at the baseof the femoral neck (Fig. 48-15). This ring is formed by contributionsfrom the medial femoral circumflex artery (MFCA) posteriorly and the lateralfemoral circumflex anteriorly.84 The capital vessels traverse the capsule close toits insertion on the neck and the trochanteric ridge and ascend parallel to theneck, entering the head adjacent to the inferior articular surface.35,73,78The superior and posterior vessels, which are derived primarily from the MFCA,have been shown to be the dominant blood supply to the femoral head.67,70,90In addition, the MFCA supplies the inferior retinacular branch that runs along theligament of Weitbrecht and supplies the inferior medial portion of the femoralhead.67,70,90 In addition to the cervical vessels, a minor contribution to the headarises from the foveal artery, a branch of the obturator artery that lies within theligamentum teres. This artery makes a significant contribution to the epiphyseal

portion of the femoral head vasculature in approximately 75% of hips

Fonte: Rockwood and Wilkin`s fractures in Adult 8th ed. Página 1996

85) É contrindicacao absoluta para artroplastia total do joelho:

d) Recurvato por fraqueza muscular

_________________________________________________________________


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86) Na hérnia discal cervical, a compressão nervosa de C6 causa alteraçãoda sensibilidade no dedo:

d) Indicador _________________________________________________________________87) Na doença de SCHUERMANN, o diagnostico mais comum é:

a) cifose postural

_________________________________________________________________

88) No pé diabético, segundo a classificacao de WAGNER, a presença deexposição de tendõescorresponde ao grau:

b) 2

_________________________________________________________________


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89) Na fratura do planalto tibial, o acesso póstero-lateral é realizado nointervalo entre os músculos:

d) gastrocnêmio lateral e bícepsfemoral

_________________________________________________________________

90) A fratura da tuberosidade da tíbia em crianças classificada por SALTER-HARRIS como tipo I, corresponde na classificação de WATSON-JONES ao tipo:d) IV

_________________________________________________________________91) No hálux rígido, segundo a classificação de COUGHLIN e SHURNAS, apresença de dor mais constante, moderada diminuição do espaço articular emoderada restrição da mobilidade, corresponde ao grau:

b) 2

_________________________________________________________________


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92) O tratamento cirurgico da fratura de coluna vertebral secundaria à osteoporose está indicado na presença ded) dor refrataria ao tratamento conservador

________________________________________________________________

93) Nas fraturas do tornozelo, é considerado parâmetro radiografia de boa

redução o:

d) espaço entre a parede medial da fíbula e a superfície da incisura da tíbia de3mm no AP.


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_________________________________________________________________94) Na pesquisa clinica da ruptura do tendão calcâneo, pede-se para o paciente emdecúbito central e com as pernas fora da mesa de exame que realize a flexão ativados joelhos até 90º. Neste momento observa-se a posição do pé, se está em flexãoplantar, neutro ou flexão dorsal. este teste foi descrito por:

a) Matles

_________________________________________________________________

95) A Sindactilia da mão ocorre mais frequentemente entre o:

c) 3º e 4º dedos

_________________________________________________________________


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96) A doença de Kienbock ocorre mais frequentemente em:

a) Mulheres entre 15 e 40 anos

_________________________________________________________________

97) Nas fraturas difamarias estáveis do fêmur acima dos 11 anos de idade,tratamento definitivo recomendado éc) osteossintese intramedular rígida com entrada trocantérica

_________________________________________________________________

98) Na síndrome compartimentar aguda, o coeficiente Delta-P é obtidosubtraindo-se a pressão

d) intracopartimental da pressão arterial diastólica

_________________________________________________________________

99) A fratura do termo distal do rádio na criança tem indicação de

tratamento emergencial quando houver:


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d) síndrome aguda do túnel do carpo

_________________________________________________________________100) A ocorrência de síndrome compartimentar crônica da perna está associada à presença de

c) hérnia fascial

_________________________________________________________________

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