TARO 1998 – 2009

TARO 2010 – 2019

TARO 2020 em diante

Gabarito TARO 2021

01 – Fonte oficial: NETTER, F. H. Atlas de Anatomia Humana. 7. ed. Rio de Janeiro: Elsevier, 2019. Cap. 7 

02 – The distal fragment is translated anteriorly, medially, and inferiorly, and rotated anteriorly. This results in the scapula being protracted.

Fonte oficial: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURTBROWN, C. M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap. 33

03 – Os achados normais para as radiografias no plano frontal são de 1 a 3 milímetros (mm) de distância entre a face lateral da articulação da clavícula e a face medial do acrômio e de 1,1 a 1,3 centímetro (cm) entre o bordo inferior da clavícula e o bordo superior do processo Coracoide.

Fonte oficial: MOTTA FILHO, G. R.; BARROS FILHO, T. E. P. Ortopedia e Traumatologia. 1. ed. Rio de Janeiro:
Elsevier, 2018. Cap 5.8

04 – Fonte oficial: NETTER, F. H. Atlas de Anatomia Humana. 7. ed. Rio de Janeiro: Elsevier, 2019. Cap 7. 

05 – It occurs more frequently between the ages of 15 and 40 years and in the dominant wrist of men engaged in manual labor

Fonte oficial: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021.
Cap 69.

06 – It is also more common in younger children than in older children and occurs most often in the humerus and
fibula and less often in the tibia, femur, radius, and ulna, in that order.
The exact incidence is difficult to
determine because of variables in the definition of
significant overgrowth and variations in the age cutoff of different
studies. In one study, 27% of child amputees experienced overgrowth severe enough to require revision surgery.
Terminal overgrowth is treated effectively with surgical resection of the excess bone. Epiphysiodesis has been
unsuccessful and is contraindicated. Capping the bone with a synthetic device has had only limited success and
has been complicated by infection or fracture of the implant or bone. Improved results have been obtained by
capping the bone with an epiphyseal graft harvested from the amputated limb at the index procedure.
Fonte oficial: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021.
Cap 14.
 

07 – The signs of midline disc herniation are those of spinal cord compression. If the lesion is high in the cervical region,
paresthesias, weakness, atrophy, and occasionally fasciculations may occur in the hands.
A Hoffman sign (upper
cervical spinal cord) or the inverted radial reflex also may be present when the pathology is at or above the C5/6
level. Most commonly, however, the first and most prominent symptoms are those of involvement of the
corticospinal tract; less commonly, the posterior columns are affected. The primary signs are sustained
clonus, hyperactive reflexes, and the Babinski reflex.
Less significant findings are varying degrees of spasticity,
weakness in the legs, and impairment of proprioception.Equilibrium may be grossly disturbed, but sense of pain
and temperature sense rarely are lost and usually are of little localizing value.
Fonte Oficial : AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021.
Cap 38.

08 – Typically. the shoulders are adducted and internally rotated, the elbow more often extended than flexed,
and the wrist flexed severely. with ulnar deviation
.
Fonte oficial:
FLYNN, J. M.; WEINSTEIN, S. L. Lovell and Winter’s pediatric orthopaedics. 7. ed. Philadelphia:
Wolters Kluwer, 2014. Cap

09 – Garden described an alignment index to measure the quality of reduction. This is based on measurement of bony
trabecular alignment on the postoperative AP and lateral radiographs.
On the AP view, the angle subtended by
the central axis of the medial trabecular system in the head and the medial cortex should normally be 160
degrees
. On the lateral view, the central trabecular axis in the head is in line with the femoral neck, an angle of 180
degrees.
Fonte oficial: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURTBROWN, C. M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 52

10 – Garden described an alignment index to measure the quality of reduction. This is based on measurement of bony
trabecular alignment on the postoperative AP and lateral radiographs.
On the AP view, the angle subtended by
the central axis of the medial trabecular system in the head and the medial cortex should normally be 160
degrees
. On the lateral view, the central trabecular axis in the head is in line with the femoral neck, an angle of 180
degrees.
Fonte oficial: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURTBROWN, C. M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 52

11 – Sectioning of the interosseous talocalcaneal ligament along with the anterior talofibular ligament produces a
significant change in subtalar motion
compared with injury to the ante- rior talofibular ligament alone
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 89.

12 – The classification of stress fractures as either “high risk” or “low risk” has been suggested by multiple
authors.20,21,26 High-risk stress fractures have at least one of the following characteristics: risk of delayed or
nonunion, risk of refracture, and significant long-term consequences if they progress to complete fracture
Anatomic Sites for High-Risk Stress Fractures
Femoral neck (tension side)
Patella (tension side)
Anterior tibial cortex
Medial malleolus
Talar neck
Dorsal tarsal navicular cortex
Fifth metatarsal proximal metaphysis
Sesamoids of the great toe
Fonte: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, 12 M. D.; COURT-BROWN,
C. M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 23.

13 – Isolated ulnar shaft reduction technique (Blount). Valgus force applied to fracture site and direct thumb
pressure over distal ligament.
Fonte: WATERS, P. M.; SKAGGS, D. L.; FLYNN, J. M. Rockwood and Wilkins’ Fractures in Children. 9. ed.
Philadelphia: Wolters Kluwer, 2020. Cap 9.

14 – The position of the bicipital tuberosity of the proximal radius can aid in assessing the amount of pronation or
supination of the proximal fragment.
The tuberosity view is taken with the elbow bent 90 degrees, the lateral
and medial epicondyles equidistant from the plate, and the radiographic tube angulated 20 degrees
posteriorly from the normal AP trajectory.
Fonte: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, 12 M. D.; COURT-BROWN,
C. M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 23

15 – Epithelioid sarcoma is a rare soft-tissue sarcoma with several unusual clinical features. It is a slow-growing
malignant tumor usually occurring in adolescents and young adults and frequently involves the distal upper
extremities, including the hands and fingers.
It is the most common sarcoma in the hand. It frequently presents
as a small (average 3 cm), superficial, soft-tissue mass. The overlying skin may be ulcerated.
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 28.

16 – Vascular injury associated with supracondylar femur fractures is uncommon, but is a potentially devastating injury
constellation. Most injuries to the superficial femoral or profunda femoris arteries occur after fractures of the femoral
shaft
. On the other hand, blunt injury to the popliteal artery most commonly occurs with knee dislocations
or displaced fractures of the proximal tibia. It is surprising, therefore, that the incidence of popliteal artery
injury is so low after supracondylar fracture, because the vascular bundle is tethered proximally in the
hiatus of the adductor magnus muscle and distally by the arch of the soleus
.
Fonte: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, 16 M. D.; COURT-BROWN,
C. M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 57.

17 – Repetitious physical activities in skeletally immature individuals can result in physeal stress–fracture
equivalents.7,39,40
The most common location for such injuries is in the distal radius or ulna, as seen in
competitive gymnasts (Fig. 7-9
); the proximal tibia, as in running and kicking sports such as soccer (Fig. 7-10);
and the proximal humerus, as in baseball pitchers.39 These injuries should be managed by rest, judicious
resumption of activities, and longitudinal observation to monitor for potential physeal growth disturbance.
Fonte:WATERS, P. M.; SKAGGS, D. L.; FLYNN, J. M. Rockwood and Wilkins’ Fractures in Children. 9. ed.
Philadelphia: Wolters Kluwer, 2020. Cap 2.

18 – The criteria for the diagnosis of typical Scheuermann disease are more than 5 degrees of wedging of at least
three adjacent vertebrae a
t the apex of the kyphosis and vertebral endplate irregularities with a thoracic
kyphosis of more than 50 degrees.
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 28.

19 – Pacientes com aumento da inclina o tibial apresentam maior incidência de ruptura do ligamento cruzado anterior.
N –
. De forma oposta, nos joelhos com insufici ncia do ligamento cruzado posterior, aumentar a inclina o
sagital da superf cie
articular da t bia pode ajudar no controle dos sintomas
Fonte: MOTTA FILHO, G. R.; BARROS FILHO, T. E. P. Ortopedia e Traumatologia. 1. ed. Rio de Janeiro: Elsevier,
2018. Cap 9.7.

20 – Fonte: NETTER, F. H. Atlas de Anatomia Humana. 7. ed. Rio de Janeiro: Elsevier, 2019. Cap 8.

21 – A score of 2 (normal), 1 (altered), or 0 (absent) is determined for each
dermatome, and specific “key” areas are identified on the diagram within each
dermatome as optimal test locations. In addition, the presence of sensation for
deep anal pressure is made to help determine if a spinal cord injury is

complete or incomplete. Important dermatomal landmarks are the nipple line (T4), xiphoid process (T7), umbilicus
(T10),
inguinal region (T12, L1), and perianal region (S4 and S5).
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 41.

22 – Fonte: NETTER, F. H. Atlas de Anatomia Humana. 7. ed. Rio de Janeiro: Elsevier, 2019.Cap 7.

23 – The dorsal tangential view is performed with the wrist in
maximal flexion and the dorsal cortex of the radius at a 15-
degree incline to the beam of the C-arm (A) which allows
visualization of the tip of the screws in relation to the dorsal
cortex of the radius (B).
Fonte: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.;
MCKEE, M. D.; COURT-BROWN, C. M. Rockwood and Green’s Fractures in adults. 9.ed. Philadelphia: Wolters
Kluwer, 2020. Cap 42.

24- The ulnar nerve is at risk in posterior elbow dislocation because of its position posterior to the medial
epicondyle
. In clinical cases, the ulnar nerve is the most common neurovascular injury.
Fonte: WATERS, P. M.; SKAGGS, D. L.; FLYNN, J. M. Rockwood and Wilkins’ Fractures in Children. 9. ed.
Philadelphia: Wolters Kluwer, 2020. Cap 15.

25 – Scoliosis is the most common skeletal manifestation of neurofibromatosis. Typically, it is located in the
thoracic spine; has a short, sharply angled curve; and involves four to six vertebrae. The reported incidence is
between 10% and 60%.
vv Reports citing high incidence rates may have been biased, however, in that they were
derived from populations of patients with neurofibromatosis managed by musculoskeletal specialists. A 10% to
20% incidence of scoliosis appears to more accurately reflect the entire population with neurofibromatosis.
Fonte:HERRING, J. A. Tachdjian’s pediatric orthopaedics. 6. ed. Philadelphia: Elsevier, 2022. Cap 9.

26 – Posterior approaches are ideally suited for procedures in
which femoral head viability is unnecessary, such as resection
arthroplasty and insertion of a proximal femoral prosthesis. If
femoral head viability is necessary, such as in hip resurfacing
arthroplasty or fracture repair,
the medial femoral circumflex
artery and its ascending branches must be protected
.
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 1.

27 – Fibrous dysplasia is a developmental anomaly of bone formation that may exist in a monostotic or polyostotic form.
The hallmark is replacement of normal bone and marrow by fibrous tissue and small, woven spicules of bone.
Fibrous dysplasia can occur in the epiphysis, metaphysis, or diaphysis. Associated abnormalities, such as sexual
precocity, abnormal skin pigmentation, intramuscular myxoma, and thyroid disease, may be present.
McCuneAlbright syndrome refers to polyostotic fibrous dysplasia, cutaneous pigmentation, and endocrine
abnormalities. Mazabraud syndrome is polyostotic fibrous dysplasia with intramuscular myxomas.
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 25.

28 – Osteosarcoma is a tumor characterized by the production of osteoid by malignant cells. It is the most common
nonhematologic primary malignancy of bone
. The incidence is 1:3 per 1 million per year.
Fonte: AZAR, F. M; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 27.

29 – Any bone may be involved, but the proximal tibia is the most common location.
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 26.
Pg 995

30 – On physical examination, displaced patella fractures typically present with an acute hemarthrosis and a tender,
palpable defect between the fracture fragments.
The absence of a large effusion in the presence of a palpable
bony defect should raise concern for associated retinacular tears.
Competence of the extensor mechanism
must be assessed by asking the patient to perform a straight-leg raise or extend a partially flexed knee against
gravity. A large hemarthrosis may be very painful, and limit the ability of the patient to comply with this part of the
examination.
Fonte: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURT-BROWN, C.
M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Capitulo 59 pg 4087

31 – Several anatomic structures are at risk during anterior ankle
arthroscopy, with most of the risk of injury occurring during
portal placement. In addition, the anterior tibial artery is at risk of injury when working in the anterior aspect of the
ankle. In an MRI study, a branch of the anterioR tibial artery was near the anterolateral portal in 6.2% of patients,
and the artery was an average of 2.3 mm from the anterior capsule. In a cadaver study, the mean distance from the
distal tibia to the anterior tibial artery was 0.9 cm when the ankle was in dorsiflexion, and the distance decreased to
0.7 cm when noninvasive distraction was applied to the ankle; thus the safe anterior working area is decreased with
distraction.
The superficial peroneal nerve often is marked preoperatively with the foot in plantarflexion and
inversion.
A cadaver study found that the nerve moves laterally when the foot is moved from plantarflexion and
inversion to neutral or dorsiflexion (which is the usual position of the foot when creaing the anterolateral portal)
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 50.
Pg 2552

32 – Os principais mediadores inflamatórios podem ser divididos em quatro grupos: interleucinas (IL-1 a IL-13), fator de
necrose tumoral (TNF e linfotoxina), interferons (IFN–alfa, beta e gama) e fatores estimuladores de colônia (GCSF, M-CSF, GM-CSF).
Desses, o marcador que melhor se correlaciona com a gravidade do trauma é a IL-
6.”
Fonte: MOTTA FILHO, G. R.; BARROS FILHO, T. E. P. Ortopedia e Traumatologia. 1. ed. Rio de Janeiro: Elsevier,
2018. Cap 2.3.

33 – Em um estudo ultrassonográfico realizado em 141 pacientes com tennis leg, foram evidenciadas 67% de lesões
parciais do músculo gastrocnêmio medial
e 1,4% de associações com a rotura do tendão plantar.
Fonte: MOTTA FILHO, G. R.; BARROS FILHO, T. E. P. Ortopedia e Traumatologia. 1. ed. Rio de Janeiro: Elsevier,
2018. Cap 15.4.

34 – Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 1.
Pg. 20

35 – Nervo supraescapular passa por baixo do
ligamento na incisura da escápula e inerva o
musculo supraespinhal; em seguida passa através da incisura espinoglenoidal (onde pode ser comprimido) para a
fossa infraespinal
Fonte: NETTER, F. H. Atlas de Anatomia Humana. 7. ed. Rio de Janeiro: Elsevier, 2019. Cap 7.

36 – Grandes lesões de Hill-Sachs, portanto, podem influenciar a conduta cirúrgica e tornar necessários outros
procedimentos além da abordagem dos defeitos de contenção da glenoide anterior.
Essas lesões geralmente
são abordadas com o preenchimento do defeito, que pode ser realizado com enxerto ósseo ou, mais
é (q f ê f “ h ”) q é
do tendão do músculo infraespinal no meio do defeito ósseo.
Fonte: MOTTA FILHO, G. R.; BARROS FILHO, T. E. P. Ortopedia e Traumatologia. 1. ed. Rio de Janeiro: Elsevier,
2018. Cap 5.6

37 – Field of view refers to the viewing angle encompassed by the lens
and varies according to the type of arthroscope. The 1.9-mm scope
has a 65-degree field of view
; the 2.7-mm scope, a 90-degree field
of view; and the 4.0-mm scope, a 115-degree field of view.
Wider
viewing angles make orientation by the observer much easier.
Rotation of the forward oblique viewing (25- and 30-degree)
arthroscopes allows a much larger area of the joint to be observed
(Fig. 49-1). Rotation of 70-degree arthroscopes produces an
extremely large field of view but may create a central blind area
directly in front of the scope (Fig. 49-2).
Fonte Oficial: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021.
Cap 49. Pg 2540

38 – Sudkamp et al. found that over half of complications found with proximal humeral locking plate fixation occurred
intraoperatively.
Primary screw perforation of the humeral head was the most common complication.
Training and a meticulous and stepwise surgical technique are the mainstays to avoid intraoperative complications.
The frequency of screw penetration was further increased in cases of fracture collapse and secondary
penetration.408 Careful selection of screw length is therefore advised. Furthermore, inadvertent head penetration
while drilling should be avoided, as this creates a path for easier head perforation.7
Fonte oficial: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M.D.; COURTBROWN, C. M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 35.

39 – The limitation of abduction, which is the most reliable sign of a dislocated hip, is best appreciated by abducting both
hips simultaneously with the child on a firm surfasse (Video 16-2).
A unilateral dislocation produces a visible
reduction in abduction on the affected side as compared with the normal side
(Fig. 16-23). Shortening of the
thigh (
Galeazzi sign) is best appreciated by placing both hips in 90 degrees of flexion and comparing the height of
the knees, again looking for asymmetry (
Fig. 16-24). Because the thigh is foreshortened, there will be more thigh
folds on the affected side than on the normal side (
Fig. 16-25). Although this sign is always present with a unilateral
dislocation, extra thigh folds are a common normal variant and do not necessarily indicate hip dislocation.
Fonte oficial: HERRING, J. A. Tachdjian’s pediatric orthopaedics. 6. ed. Philadelphia:
Elsevier, 2022. Cap.13.

40 – Descompression includes removal of the loose L5 lamina (Gill procedure), followed by L5 nerve root
descompression all the way out to the sacral ala.
Fonte oficial: HERRING, J. A. Tachdjian’s pediatric orthopaedics. 6. Ed. Philadelphia:
Elsevier, 2022. Cap 11.

41 – Rupture of the C5-6 disc with compression of the C6 root can be confused with Other root levels because os dual
innervation of structures. Weakness may be noted in the bíceps and extensor carpi radialis longus and brevis. As
mentioned earlier, the bíceps is dually innervated by C5 and C6, whereas the long extensors are dually innervated
by C6 and C7. The brachioradialis and bíceps reflexes also may be diminished at this level. Sensory testing
usually indicates a decreased sensibility over the lateral proximal forearm, thumb, and index finger.
Fonte oficial: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed.
Philadelphia: Elsevier, 2021. Cap. 38.

42 – Cervical spine injuries in children younger than 8 years of age occur in the upper cervical spine, whereas older
children and adolescents tend to have fractures involving either the upper or lower cervical spine. The upper
cervical spine in children is more prone to injury because of the anatomic and biomechanical properties of the
immature spine.
The immature spine is hypermobile because of ligamentous laxity, and the facet joints are
oriented in a more horizontal position; both of these properties predispose children to more forward
translation
. Younger children also have a relatively large head compared to the body, which changes the fulcrum
of motion of the upper cervical spine. All of these factor predispose younger children to injuries of the upper cervical
spine.
Fonte oficial: WATERS, P. M.; SKAGGS, D. L.; FLYNN, J. M. Rockwood and Wilkins’
Fractures in Children. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 20.

43 – Fonte oficial: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed.
Philadelphia: Elsevier, 2021.. Cap 44.

44 – As raízes ventrais de C5 e C6 se unem para formar o tronco superior. A raiz de
C7 forma o tronco médio.
Narakas (1987) classificou as crianças co POPB em quatro grupos:
Grupo 1: lesão apenas das raízes de C5 e C6 (Erb): comprometimento da abdução e rotação externa do
ombro e da flexão do cotovelo. Bom prognóstico, com recuperação espontânea em 80 a 90% dos casos.

Grupo 2: acometimento das raízes de C5, C6 e C7 (Erb estendida): além dos músculos paralisados
no grupo 1, observa-se também perda x h ( “ j ”).
Recuperação espontânea em torno de 60% dos casos.
Grupo 3: lesão de todas as raízes do plexo (flail arm). Recuperação total não é possível. De 30% a 50%
dos pacientes podem recuperar espontaneamente o ombro e o cotovelo.
Grupo 4: apresenta o sinal de Claude Bernard-Horner associado à lesão total. É o de pior prognóstico.
Fonte oficial: MOTTA FILHO, G. R.; BARROS FILHO, T. E. P. Ortopedia e Traumatologia. 1.
ed. Rio de Janeiro: Elsevier, 2018. Cap 11.10.

45 – A síndrome do desfiladeiro cervicotorácico
caracteriza-se por sinais e sintomas
causados por compressão dos elementos
do plexo braquial, artéria ou ve ias subcláv
ias na saída da caixa ro rácica.
Representa um grupo de desordens
heterogêneas e potencialmente
incapacitantes no membro superior e que
são causadas por compressão extrínseca
entre a primeira costela e a clavícula. São
vários os pontos em que as estruturas
vasculares e nervosas podem ser
comprimidas:
l. Triângulo formado pelos músculos escalenos anterior e médio.
2. Entre a clavícula e o músculo subclávio, anteriormente, e a primeira costela, posteriormente.
3. Entre o processo coracoide e o músculo peitoral menor, anteriormente, e a membrana costocoracoidiana
posteriormente.
Fonte oficial: MOTTA FILHO, G. R.; BARROS FILHO, T. E. P. Ortopedia e Traumatologia. 1.
ed. Rio de Janeiro: Elsevier, 2018. Cap 7.4.1. pág 855

46 – Symptomatic neuromas occur in approximately 7% os traumatic amputations and are most common in the
index finger and avulsion type injuries.
Fonte oficial: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed.
Philadelphia: Elsevier, 2021. Cap. 19.

47 – The PITFL arises from Volkmann’s tubercle of the posterior malleolus. It is extremely strong and in trimalleolar
fractures the fragment usually remains solidly attached to the fibula via this ligament.
Fonte: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURT-BROWN, C.
M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap. 64 – Pg: 4531

48 – A group of fractures that have in common the appearance of a Salter–Harris type III fracture on the
anteroposterior radiographs and of a Salter–Harris type II fracture on the lateral radiographs
(Fig. 32-11).
CT scans can be very helpful to understand the complex anatomy of these fractures (Fig. 32-11).14,49,107
Ipsilateral triplane and diaphyseal fractures have been reported, and one of the fractures can be missed if
adequate images are not obtained.14,49,9
Fonte: WATERS, P. M.; SKAGGS, D. L.; FLYNN, J. M. Rockwood and Wilkins’ Fractures in Children. 9. ed.
Philadelphia: Wolters Kluwer, 2020. Cap. 29 – Pg: 1178-1178

49 – The most common presenting complaint for patients with sacrococcygeal tumors is low back pain.
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 27
– Pg: 1021

50 – “An example is a small asymptomatic nonossifying fibroma discovered incidentally
on radiographs taken to evaluate an unrelated injury (Fig. 24.2 .”
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 24
– Pg: 893-894

51 – Some benign bone lesions, such as osteoid osteoma and osteochondroma, have a characteristic
radiographic appearance and can be primarily resected, if indicated, without biopsy
.
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 24
– Pg: 898

52 – Avulsion fractures of the tibial tubercule rarely result in tibial deformity because they occur toward the end of
growth; however,
posttraumatic genu recurvatum can occur in younger patients. This is caused by premature
arrest of the anterior aspect of the growth plate. Patients with more than 1 year of growth remaining should be
observed with serial lateral knee radiographs for development of this deformity. Bilateral proximal tibial
epiphysiodesis is generally the preferred procedure when deformity is mild. Greater degrees of deformity may
necessitate proximal tibial flexion osteotomy to restore normal alignment
Fonte: FLYNN, J. M.; WEINSTEIN, S. L. Lovell and Winter’s pediatric orthopaedics. 7. ed. Philadelphia: Wolters
Kluwer, 2014. Cap 34 – Pg: 1808

53 – Salter–Harris type III fractures of the medial femoral condyle are most frequently associated with anterior cruciate
ligament injuries.
Fonte: WATERS, P. M.; SKAGGS, D. L.; FLYNN, J. M. Rockwood and Wilkins’ Fractures in Children. 9. ed.
Philadelphia: Wolters Kluwer, 2020. Cap 25 – Pg: 1530

54 – Remodeling continues for up to 5 years following fracture. Approximately 25% of remodeling occurs at the fracture
site, whereas 75% is attributed to physeal reorientation and longitudinal growth.
Fonte: FLYNN, J. M.; WEINSTEIN, S. L. Lovell and Winter’s pediatric orthopaedics. 7. ed. Philadelphia: Wolters
Kluwer, 2014. Cap 34 – 1786

55 – Resposta: “Pronation will stabilize the LCL-deficient elbow while supination decreases stability in this setting.”
Fonte: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURT-BROWN, C.
M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 39 – Pg: 2320

56 – The direction of fracture displacement often indicates whether the medial or
lateral periosteum remains intact.
With a posteromedially displaced fracture,
the medial periosteum is usually intac
t. Elbow flexion and forearm
pronation places the medial and posterior periosteum on tension, which
corrects varus and extension malalignment and adds to stability of fracture
reduction (Fig. 16-5).
The medial periosteum however is often torn in a
posterolaterally displaced fracture, in which case pronation may be
counterproductive. Instead, in a posterolaterally displaced supracondylar
fracture, forearm supination in addition to flexion may be better because the
lateral periosteum is usually intact. If the posterior periosteal hinge is also
disrupted, the fracture becomes unstable in both flexion and extension and this has been recently described as a
multidirectionally unstable, modified Gartland type IV fracture.118
Generally, medial displacement of the distal fragment is more common than lateral displacement, occurring in
approximately 75% of patients in most series. Whether the displacement is medial or lateral is important because it
determines which soft tissue structures are at risk from the penetrating injury of the proximal metaphyseal
fragment. Medial displacement of the distal fragment places the radial nerve at risk, and lateral displacement of the
distal fragment places the median nerve and brachial artery at risk (Fig. 16-6).

FONTE: WATERS, P. M.; SKAGGS, D. L.; FLYNN, J. M. Rockwood and Wilkins’ Fractures in Children. 9. ed.
Philadelphia: Wolters Kluwer, 2020. Cap 13.

57 – Bilateral fractures of the inferior and superior pubic rami may occur in a fall while straddling a hard object, by lateral
compression of the pelvis, or by sudden impact while riding a motorized cycle
. The floating fragment usually is
displaced superiorly, pulled in this direction by the rectus abdominis muscles.
98 As with ipsilateral superior
and inferior pubic ram fractures, which may occur by similar mechanisms, bladder, or urethral disruptions59 are
commonly associated injuries that must be ruled out in patients with this type of pelvic fracture.
FONTE: WATERS, P. M.; SKAGGS, D. L.; FLYNN, J. M. Rockwood and Wilkins’ Fractures in Children. 9. ed.
Philadelphia: Wolters Kluwer, 2020. Cap 22.

58 – FONTE: SIZÍNIO, HEBERT; BARROS FILHO, T. E. P.; XAVIER, Renato; PARDINI JÚNIOR, A. G. Ortopedia e
Traumatologia: Princípios e Prática. 5. ed. Porto Alegre: Artmed, 2017. Cap 9.

59 – Freiberg infraction, also known as Freiberg disease, usually occurs in
the head of the second metatarsal but also may occur in the third (
Fig.
32.22
), fourth, and fifth metatarsals in adolescent patients. Surgery is not
recommended during the acute stage, which may persist for 6 months to 2
years. It may be indicated later because of pain, deformity, and disability.
Occasionally, a loose body is present (
Fig. 32.23), and simply removing it may
relieve the symptoms. Other procedures used include scraping the sclerotic
area and replacing it with cancellous bone (Smillie procedure), osteochondral
plug transplantation (
Fig. 32.24), dorsal wedge osteotomy, temporary joint
spacer, and total joint arthroplasty
FONTE: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 12. ed. Philadelphia: Elsevier, 2017.
Cap 32.

60 – Although tarsal coalition has long been cited as a cause of congenital rigid pes planus, this is inaccurate. Some
patients with a tarsal coalition, especially calcaneonavicular coalition, have little deformity suggestive
of pes planus. Slight heel valgus and minimal loss of the longitudinal arch may be present but
f q y h ’ . I y f y y .
This is
especially true of calcaneonavicular coalition, which might allow enough subtalar motion to delude the
examiner before radiographic evaluation. Most patients with tarsal coalition do have a fixed hindfoot valgus of
varying severity
FONTE: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 12. ed. Philadelphia: Elsevier, 2017.
Cap 82.

61 – “Testes seletivos da for a do tend o fibular longo s o realizados com o tornozelo mantido em evers o
empurrando a coluna medial no n vel da cabe a do primeiro metatarso.”
FONTE: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 12. ed. Philadelphia: Elsevier, 2017.
Cap 82.

62 – A neuropatia diabética é a causa básica para o surgimento de úlcera nos pés diabéticos. Esse é um ponto
importante, pois, com frequência, o paciente pensa que a úlcera diabética é causada pela diminuição ou falta de
circulação sanguínea, o que não é verdade. A maioria das úlceras em pés diabéticos – cerca de 80% – é causada
pela neuropatia.
FONTE: SIZÍNIO, HEBERT; BARROS FILHO, T. E. P.; XAVIER, Renato; PARDINI JÚNIOR, A. G. Ortopedia e
Traumatologia: Princípios e Prática. 5. ed. Porto Alegre: Artmed, 2017. Cap 21.

63 – FONTE: NETTER, F. H. Atlas de Anatomia Humana. Tradução 2. ed. Rio
de Janeiro: Elsevier, 2012. Cap. 10

64 – As recidivas que ocorrem em crianças menores de 2 anos devem ser novamente submetidas ao
tratamento pelo método de Ponseti
. A única diferença é que o gesso deve permanecer por duas semanas em
vez de uma, para dar mais tempo de adaptação ao tecido conectivo. É frequente que duas ou três trocas sejam
suficientes e a criança volte a usar a órtese no período de sono. Quando uma criança é submetida mais uma vez
ao método e não alcança 15° de dorsiflexão, deve ser submetida a uma nova tenotomia percutânea. O
alongamento do Aquiles pode ser uma opção em casos assim.21 Embora seja possível tratar as recidivas com a
reaplicação do método, a melhor forma de tratar é prevenindo que elas aconteçam por meio do uso correto da
órtese e da reavaliação rotineira.73
FONTE: SIZÍNIO, HEBERT; BARROS FILHO, T. E. P.; XAVIER, Renato; PARDINI JÚNIOR, A. G. Ortopedia e
Traumatologia: Princípios e Prática. 5. ed. Porto Alegre: Artmed, 2017. Cap 20.

65 – The locked plate does not have to touch the bone surface and therefore interferes less with the periosteal blood
flow. Because the conventional screw does not engage the plate when load is applied, the screw has no angular
stability, thus, it relies onte the frictional forces between the plate and bone for stability. The locking screw engages
into the plate and is able to resist the load because of the screw head threading into the plate, thus, it is a fixed
angle device.
FONTE: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURT-BROWN, C.
M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 11.

66 – O envolvimento das articulações metacarpofalangeanas dos dedos é excepcional, sendo mais comum o
acometimento
por osteoartrite secundária resultante de fraturas articulares e lesões ligamentares e de placa
volar, que causam frouxidão crônica da articulação.
SIZÍNIO, HEBERT; BARROS FILHO, T. E. P.; XAVIER, Renato; PARDINI JÚNIOR, A. G. Ortopedia e
Traumatologia: Princípios e Prática. 5. ed. Porto Alegre: Artmed, 2017. Cap 7.

67 – A corda espiral tem origem em várias estruturas: banda pré-tendinosa, banda espiral, bainha digital lateral e
ligamento de Grayson. Essa corda é responsável pelo desvio anterior do feixe neurovascular para a linha mediana
do dedo, colocando-o em risco durante a abordagem cirúrgica.
MOTTA FILHO, G. R.; BARROS FILHO, T. E. P. Ortopedia e Traumatologia. 1. ed. Rio de Janeiro: Elsevier, 2018.
Cap. 7.13.

68 – The hand deformities are tipically symmetrical. Upton classified the Apert hand into three types. Type 1 or “spade
hand´´ has a separate thumb whith complete syndactyly of the remaining digits
. Type 2 or “spoon hand´´ has
syndactyly involving all the digits, The hand is spoon shaped, with a tapering terminal end and complex
syndactyly of the index, long, and ring fingers.
The little finger usually shows complete simple syndactyly with
the ring fingers. The fingers have limited motion because of incomplete joint development, and they usually are
shortened. Type 3 or “rosebund hand´´ has complex syndactyly with distal synostosis between the thumb and the
index long, and ring fingers.
Fonte Oficial: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021.
Cap. 80.

69 – Traumatic dislocation of the extensor tendon toward the ulnar aspect of the metacarpophalangeal joint
occurs most commonly in the longer finger
. The dislocation usually occurs as a result of a tear in the
proximal radial portion of the shroud ligament (sa
gital bands) and the more proximal fascia as the finger is
suddenly extended against force, as in a flicking or thumping motion. Ulnar side disruption with radial displacement
of the tendon is rare.
Fonte Oficial: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021.
Cap. 66.

70 – O diagnóstico de fraturas que acometem o hámulo do hamato é obtido em radiografias do túnel do carpo e na
incidência obliqua em supinação em 45o.
SIZÍNIO, HEBERT; BARROS FILHO, T. E. P.; XAVIER, Renato; PARDINI JÚNIOR, A. G. Ortopedia e
Traumatologia: Princípios e Prática. 5. ed. Porto Alegre: Artmed, 2017. Cap 52.

71 – Instead, unstable fractures have been predominantly defined by the failure to maintain a successful closed
reduction. Irreducible fractures ususally
are due to na entrapped periosteum or pronator quadratus.
WATERS, P. M.; SKAGGS, D. L.; FLYNN, J. M. Rockwood and Wilkins’ Fractures in Children. 9. ed. Philadelphia:
Wolters Kluwer, 2020. Cap 8.

72 – Fonte Oficial :NETTER, F. H. Atlas de Anatomia Humana. 7. ed. Rio de Janeiro: Elsevier, 2019. Cap 7.

73 – A discrepância dos membros inferiores ocorre em cerca de 43% do casos de fraturas multifragmentárias. O
comprimento deve ser medido logo após a colocação da haste, comparando com o lado contralateral
e
corrigido no próprio ato cirurgico.
SIZÍNIO, HEBERT; BARROS FILHO, T. E. P.; XAVIER, Renato; PARDINI JÚNIOR, A. G. Ortopedia e
Traumatologia: Princípios e Prática. 5. ed. Porto Alegre: Artmed, 2017. Cap 60.

74 – Pigmented villo- nodular synovitis (PVNS) is a benign tumor of the synovium. PVNS is a rare cause of episodic joint
effusions (107, 108). The effusions are minimally painful and cause progressive cartilage destruction and bone
erosions (Fig. 11-6A).
Synovial aspirates that are very bloody should arouse suspicion of the diagnosis.
Magnetic resonance imaging (MRI) can be helpful, but confirmation of the diagnosis is made by synovial
biopsy showing nodular hypertrophy, with proliferating fibroblasts and synovial cells, and hemosiderinladen macrophages
(Fig. 11-6B). Treatment consists of surgical excision. However, recurrence is frequent and
multifocal disease can occur.
Fonte Oficial: FLYNN, J. M.; WEINSTEIN, S. L. Lovell and Winter’s pediatric orthopaedics. 7. ed. Philadelphia:
Wolters Kluwer, 2014. Cap 11.

75 – Bridgman encontrou incidência de capsulite adesiva em 10,8% de diabéticos, em comparação com 2,3% no grupo
controle de não diabéticos, sendo os casos insulinodependentes mais suscetíveis ao desenvolvimento da doença.
Nos casos de diabetes tipo 1, a incidência da doença pode chegar até a 40%. Normalmente, os pacientes
diabéticos apresentam um quadro clínico mais grave e com pior prognóstico, sendo comum a associação com
outras doenças, como o dedo em gatilho e a contratura de Dupuytren.
Fonte Oficial: MOTTA FILHO, G. R.; BARROS FILHO, T. E. P. Ortopedia e Traumatologia. 1. ed. Rio de Janeiro:
Elsevier, 2018. Cap 5.4.

76 – Locking plates have several theoretical advantages, especially when used in patients with severe
osteopenia.
Schuster et al.199 demonstrated that locking 3.5-mm reconstruction plates applied orthogonally
had superior cyclic failure properties when compared to conventional nonlocked plates applied in a similar
fashion in cadavers with low bone mineral density.
Fonte Oficial: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURTBROWN, C. M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap. 38.

77 – Fonte Oficial: WATERS, P. M.; SKAGGS, D. L.; FLYNN, J. M.
Rockwood and Wilkins’ Fractures in Children. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap. 18.

78 – Os cistos dos meniscos laterais são mais comuns do que no lado medial em uma proporção de 7:1. A maioria
ocorre na base do menisco ou sobre ela. Aproximadamente 50% dos cistos aparecem associados a lesões
meniscais do tipo horizontal, que é a maior responsável pelos sintomas. Geralmente os cistos meniscais são
anteriores ao ligamento colateral lateral (LCL).
Fonte Oficial: MOTTA FILHO, G. R.; BARROS FILHO, T. E. P. Ortopedia e Traumatologia. 1. ed. Rio de Janeiro:
Elsevier, 2018. Cap 9.3.

79 – Identify the medial border of the medial gastrocnemius and bluntly develop the interval between it and the
semimembranosus tendon, exposing the posterior joint capsule (Fig. 45.134).
Fonte Oficial: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021.
Cap 45.

80 – NOTA: NA REFERENCIA BIBLIOGRAFICA DA PROVA NÃO EXISTIA REFERENCIA SOBRE TAL FATO.
ENTÃO, ENCONTRAMOS A REFERENCIA NO CAMPBELL 14ª EDIÇÃO PAG 571
Turi et al. described an opening wedge osteotomy with a dynamic uniplanar external fixator using hemicallotasis
techniques. In this procedure, the medial osteotomy is made below the tibial tuberosity.
A dynamic external
fixator is applied, and beginning 7 days postoperatively, the fixator is distracted 0.25 mm four times a day
until correction is obtained
. Five-year and 10-year survivorships of 89% and 63%, respectively, have been
reported after this procedure, with few serious complications, although superficial pin track infections were frequent.

81 – Satish et al. found the modified Keblish approach useful in total knee arthroplasty in patients with fixed
valgus knees.
The approach relies on a quadriceps snip and coronal Z-plasty of lateral retinacular capsule
complex.

Fonte Oficial: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021.
Cap 7.

82 – ROTAÇÃO PÉLVICA NO PLANO TRANSVERSO
Na deambulação, a pelve sofre uma rotação de aproximadamente 4o para cada lado, proporcionando, em
concomitância com a flexão do quadril, um deslocamento anterior. Isso ocasiona uma menor oscilação vertical do
tronco, reduzindo o deslocamento excessivo do centro de gravidade do corpo.
Fonte Oficial: LEITE, N. M.; FALOPPA, F. Propedêutica Ortopédica e Traumatologia. 1. ed. Porto Alegre: Artmed,
2013. Cap. 20.

83 – A Sbot utilizou o capítulo 54 do Campbell 14ª edição como referencia bibliográfica e não indicou em qual página
está a resposta.
Pag 2861 – In their review of 190 proximal tibial articular fractures, 67% of meniscal injuries occurred in plateau
fracture patterns, whereas 96% of cruciate injuries and
85% of medial collateral ligament injuries occurred in
fracture-dislocation patterns.
Peroneal nerve injury was twice as common in fracture-dislocation patterns.
Pag 2866 – Ligament injuries occur in 10% to 33% of tibial plateau fractures.
Pag 2870 – Ligamentous injuries have been reported in 4% to 33% of tibial plateau fractures and 60% of fracturedislocations.
The medial collateral ligament is most commonly injured, usually with undisplaced or local
depression fractures of the lateral tibial condyle.
Stress radiographs are helpful in making this diagnosis. A
prospective study of 30 tibial plateau fractures with operative repair, found a 56% incidence of additional soft-tissue
injury; 20% of fractures were associated with meniscal tears, 20% had medial collateral ligament injury, 10% had
anterior cruciate ligament injury, 3% had lateral collateral ligament injury, and 3% had peroneal nerve injury. Medial
colateral ligament injury occurred most often with Schatzker type II fractures, whereas meniscal injury occurred
most often with Schatzker type IV fractures.
Rockwood 9ª edição (não foi referência bibliográfica para a questão) diz:
Ligament and Meniscal Injuries (capítulo 61)

There is a high incidence of ligament and meniscal injuries associated with tibial plateau fractures. When assessed
by MRI, one study found that even minimally displaced tibial plateau fractures indicated for nonoperative treatment
had a high percentage of these injuries
(meniscal 80%, ligament 40%).142
In another study of MRI findings in 103 patients with operatively treated tibial plateau fractures,
all but one patient
had some soft tissue injury with lateral meniscus (91%) most commonly followed by ACL (77%),
posterolateral corner 4267 (68%), and medial meniscus (44%).47
In another study, the incidence of meniscal injury in split depression patterns was found to correlate with the degree
of depression and condylar widening.47 Looking specifically at ligament injuries using stress radiographs and
intraoperative findings, Delamarter et al.35 found that in 39 tibial plateau fractures evaluated, there were 22 MCL, 8
LCL, 1 ACL, and 8 combined ligament injuries. Unfortunately, the clinical significance of the e soft tissue injuries
when associated with a tibial plateau fracture is not known.
Fonte Oficial: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021.
Cap 54.

84 – The typical mechanism for a posterior dislocation is a deceleration ccident in which the occupant’s knee strikes the
dashboard with both the knee and hip flexed. Letournel119,120 used vector analysis to explain that the more
flexion and adduction the hip is in when a longitudinal force is applied through the femur, the more likely a pure
dislocation will occur (Fig. 51-1).119,120
Less adduction or less internal rotation favors a fracture–
dislocation, which may occur with a posterior wall fracture or a shearing injury of the femoral head as the
head impacts against the posterior wall.
The latter case results in a Pipkin-type injury with a fragment of the
femoral head remaining in the acetabulum and the intact portion dislocating posteriorly.
Fonte Oficial. TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURTBROWN, C. M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 51. (
pag. 3096 )

85 – Isolated Fractures of the Lesser and Greater Trochanter
Care is needed in making this diagnosis of an isolated fracture of the greater trochanter, as there is a risk of an
extension of the fracture line between the trochanters (Fig. 53-8). Supplementary imaging ideally with an MRI scan
may be necessary to confirm the fracture involves only the greater trochanter.
Isolated fracture of the lesser
trochanter is an uncommon injury. The fracture may be pathologic related to local tumor, particularly if
there is no history of trauma (Fig. 53-9). In such cases, further investigation may be indicated.
Fonte Oficial: . TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURTBROWN, C. M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 53. (
pag 3671 )

86 – THA can be performed in either an acute or delayed fashion. Acute THA may be very helpful in elderly patients
who have severe articular impaction and a femoral head injury
.173However, impaction of the acetabular
component into an unfixed fracture is technically challenging and may be associated with early acetabular cup
loosening.173,200,242Therefore, in fractures with unstable column fractures, fixation to stabilize the columns
should be performed in combination with THA. This fixation can be performed in an open or percutaneous fashion.
TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURT-BROWN, C. M.
Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 50. ( pag 3465

87 – CLINICAL FEATURES
History.
A detailed history provides important information critical to the diagnosis of musculoskeletal infection in
children.
Pain is the most common symptom in patients with bone or joint sepsis {63, 64), but children are
not always able to verbalize this common symptom. Instead, children may refuse to walk, refuse to bear
weight, limp, or refuse to use or move a limb.
Frequently, the physician obtains the history indirectly
from a parent or caregiver instead of obtaining it directly from the patient. Careful questioning can provide important
information
about the infection location, likely causative organisms,
and the duration of the infectious process.
87 FLYNN, J. M.; WEINSTEIN, S. L. Lovell and Winter’s pediatric orthopaedics. 7. ed. Philadelphia: Wolters
Kluwer, 2014.. Cap 12. ( pag 373 )

88 – Figure 11-6 A screw is a mechanical device that converts torque into compression between objects.
The screw thread is actually an inclined plane that slowly pulls the objects it is embedded into together. (Fn, normal
or compressive force acting against the screw head;
Ft, tangential or frictional force acting along the screw thread;
Fz, resultant of the two forces; α, angle of the screw thread. The smaller the angle α [finer thread] the lower the
frictional force.)
Fonte Oficial: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURTBROWN, C. M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 11. (
pag 623)

89 – PYOGENIC VERTEBRAL OSTEOMYELITIS AND DISCITIS
Pyogenic vertebral osteomyelitis and discitis represent 3% to 5% of all cases of pyogenic osteomyelitis.
There is a bimodal age distribution with a small peak in childhood and then a
larger spike in adulthood around the age of 50. Males are affected more frequently than females. Pyogenic
osteomyelitis and discitis are most common in the lumbar spine (50% to 60%), followed by thoracic (30% to 40%)
and cervical spine (10%).
INFECTIONS OF THE SPINE
Spinal infections are relatively uncommon but serious conditions, accounting for 3% to 5% of all osteomyelitis
cases.
89. AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed.
Philadelphia: Elsevier, 2021. Cap. 42. ( pag 1924 )

90 – The occipitocervical region is stabilized by numerous ligaments. A pair of durable capsules stabilize the
occipitocervical joints, which form the articulations between the superior articular facets of the atlas and the
occipital condyles. A broadsheet of fibrous tissue extends from the posterior border of the foramen magnum to the
superior surface of the C1 ring. This is the tectorial membrane, which is analogous to the PLL in the lower cervical
spine. A loose and flexible sheet of fibrous tissue spans between the lower occiput and the posterior C1 ring. This
is called the posterior atlantooccipital membrane and is analogous to the ligamentum flavum at other levels.
Entering this membrane approximately 1.5 cm from the posterior midline is the vertebral artery (Fig. 47-17).
The artery emerges lateral and posterior to the membrane from the transverse foramen of the atlas. This vessel
can be injured with extensive exposure of the posterior C1 ring. The ligamentum nuchae is a thick condensation of
supraspinous fibrous bands. This structure overlays the spinous processes of the cervical vertebrae and extends
from the inion to C7.
Figure 47-17
During exposure of the posterior C1 arch, dissection should not extend beyond 1.5 cm in the
posterior midline, or 1 cm along the superior border, in order to avoid injury to the vertebral artery.

90. TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURT-BROWN, C. M.
Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 47. ( pag2955 )

91 – Spence et al. published their work in 1970 on injuries to the
transverse ligament in association with C1 fractures in 10 cadaver specimens.
They found that if the total lateral
displacement of the lateral masses was 6.9 mm or more, then the transverse ligament was likely
incompetent (Fig. 41.16)
.
This determination based on plain radiographs is referred to as the rule of Spence. Later, this was revised to 8.1
mm to account for magnification on plain radiographs
Fonte Oficial: 91 AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed.
Philadelphia: Elsevier, 2021. Cap 41. ( pag. 1855 ).

92 – “Hawkins” sign is seen at 8 weeks after surgery due to subchondral resorption of bone, confirming that the
vascularity of the talar body is intact. B: At 1 year following injury, there is complete remodeling of the bone and the
subchondral lucency is no longer visualized. Página 4662
Fonte: TORNETA III, P.; RICCI, W. M.; OSTRUM, R. F.; MCQUEEN, M. M.; MCKEE, M. D.; COURT-BROWN, C.
M. Rockwood and Green’s Fractures in adults. 9. ed. Philadelphia: Wolters Kluwer, 2020. Cap 65.

93 – The most common presentation of ACS in children involves the lower leg following a tibia and/or fibula
fracture.13,15 A retrospective review over 13 years identified 1,407 patients with tibial fractures. Of these patients,
160/1,407 (11%) developed CS.
Youth was the strongest predictor of developing CS.23 Treatment of tibial
fractures with flexible nails has been shown to be associated with CS. Other risk factors include comminuted
fractures, weight >50 kg or a neurologic deficit.26 CS is also a well-known complication following tibial osteotomies
for angular and/or rotational correction. In the lower leg, a one- or two-incision technique can be employed for
decompressive fasciotomy of all four compartments, including the anterior, lateral, superficial posterior, and deep
posterior compartment (Table 5-4). In the two-incision technique (Fig. 5-10A), the anterolateral incision provides
access to the anterior and lateral compartments. The posteromedial incision must be lengthy enough to allow for
decompression of the superficial posterior compartment (more proximal) and deep posterior compartment (more
distal). The soleus origin should be detached from the medial aspect of the tibia. All four compartments of the lower
leg can also be adequately decompressed with a single-incision technique (Fig. 5-10B). The long lateral incision
typically extends 3 to 5 cm within either end of the fibula.
Fonte: WATERS, P. M.; SKAGGS, D. L.; FLYNN, J. M. Rockwood and Wilkins’ Fractures in Children. 9. ed.
Philadelphia: Wolters Kluwer, 2020. Cap 5

94 – The diagnosis of tennis elbow is made by localizing discomfort to the origin of the extensor carpi radialis brevis.
Tenderness typically is present over the lateral epicondyle approximately 5 mm distal and anterior to the midpoint
of the condyle. Pain usually is exacerbated by resisted wrist dorsiflexion and forearm supination, and there is pain
when grasping objects. Plain radiographs usually are negative; occasionally, calcific tendinitis may be present.
MRI
shows tendon thickening with increased T1 and T2 signal intensity.
One study showed that excellent surgical
results corresponded with a high-signal intensity focus on T2-weighted images of the extensor carpi radialis brevis
at the lateral epicondyle.
Fonte: 94 AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap
46. Pagina 2409

95 – A cleft sign can be seen on MRI when there is a tear of the ligamentous capsule that envelops the
fibrocartilaginous disc of the symphysis.
Other related MRI findings include tendinosis of the rectus abdominis
and adductor longus insertions into the pubis; chronic strains of these tendons frequently are confused with true
osteitis púbis.
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 6.
Pag 389

96 – Rhesus blood group incompatibility resulting in ker- nicterus as a cause of CP is decreasing in incidence with
improvements in prenatal care.
RhoGAM treatment of Rh- negative mothers has led to a decline in
kernicterus, which often resulted in the development of such movement disorders as athetoid CP.
Fonte: HERRING, J. A. Tachdjian’s pediatric orthopaedics. 6. ed. Philadelphia: Saunders, 2022. Cap 31. Pag 1421

97 – The location of the single cannulated screw does influence the result of in situ fixation. A relatively inferior position,
avoiding the superior and anterior quadrant of the epiphysis, has been suggested to result in the fewest
complications.
Fonte: HERRING, J. A. Tachdjian’s pediatric orthopaedics. 6. ed. Philadelphia: Saunders, 2022. Cap 15. Pag 592

98 – Fonte AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 32.
Pag 1277

99 – Fonte: 99 AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap.
53. Pag 2779

100 – Retrograde femoral nailing may be beneficial in the following clinical situations: (1) obese patients, in whom it is
difficult to obtain an antegrade entry portal;
(2) patients with ipsilateral femoral neck and shaft fractures, to
allow the use of separate fixation devices for the shaft and neck fractures; (3) patients with floating knee injuries, to
allow fixation of the femoral and tibial fractures through the same anterior longitudinal incision; (4) multiply-injured
trauma patients, to decrease operative time by not using a fracture table, which allows multiple injuries to be
treated by preparing and draping simultaneously; and (5) pregnant patients, such that intraoperative fluoroscopy is
minimized around the pelvis. An intercondylar portal is favored for insertion. It is important to remember that
retrograde nailing is more reliable in controlling distal shaft fractures, whereas antegrade nailing provides better
control of proximal shaft fractures.
Fonte: AZAR, F. M.; BEATY, J. H. Campbell’s operative orthopaedics. 14. ed. Philadelphia: Elsevier, 2021. Cap 54
Pag 2900
 

Traumatologia e Ortopedia

New Report

Close