Teot 2015

TEOT prova verde
Pedro Braga Linhares Garcia
1. Localização mais comum do granuloma eosinofílico na coluna?

Não encontrei resposta em livro nenhum, mas tinha nesse resumo.
R: torácica
2. No desvio de radial para ulnar do punho, a fileira proximal do carpo faz qual
desvio?
Pardini traumatismos da mão 4 ed. p 494.
R: desvio dorsal da primeira fileira

No desvio ulnar do punho, os ossos da segunda fileira são solidários ao hamato e
desviam-se para o lado ulnar (medial) em monobloco. No desvio radial, a fileira distal
empurra o escafoide proximalmente e este então empurra o semilunar e o piramidal, que
giram no plano frontal para o lado ulnar. No desvio radial do punho, o semilunar gira
ventralmente, acompanhando o escafoide o escafoide, que é fletido. No desvio ulnar, o
semilunar gira para o lado dorsal, acompanhando a verticalização do escafoide.
FIGURA 20.9: radiografias em PA com desvio ulnar mostrando o alongamento do

escafoide e em perfil com desvio ulnar evidenviando a angulação dorsal do semilunar
acompanhando o escafoide.
3. Ficat – Arlet osteonecrose de Joelho: qual grau há fratura subcondral e colapso

articular?
R: III
A osteonecrose pode ser classificada de acordo com as imagens radiográficas da lesão
ou pelo grau de artrose de Ficat e Arlet, em quatro estágios:
• Estágio I – joelhos com aparência normal;
• Estágio II – joelhos com lesões císticas ou escleróticas, ou ambas, contorno normal da
tíbia e/ou fêmur e sem fraturas subcondrais ou achatamento da superfície articular;
• Estágio III – joelhos com sinal do crescente e colapso subcondral;
• Estágio IV – joelhos com redução do espaço articular, cistos, osteófitos
https://blu169.afx.ms/att/GetAttachment.aspx?file=13343377-…15065a61411ea5e2662a4c6432d3cdefb95e430c7a&oneredir=1 08/03/16 15:13

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4. Classificação de Wassel? Duplicação do polegar: trifalangismo.
Campbell 11th p 4410
R: Tipo VI (trifalangismo)
5. Trauma em hiperpronação:
a) fratura transversa do rádio
b) fratura do rádio no mesmo nível da ulna ou
c) nível diferente
d) fratura do rádio com luxação da RU proximal
RW 6th p 404
R: C
6. Teste de pivot-shift para cotovelo: qual instabilidade é testada?

Osvandré
R: instabilidade posterolateral.
7. Idade óssea: radiografia do punho da mão. Qual mais? Cotovelo, joelho, ombro
ou tornozelo?
Não achei.
R: Cotovelo ou tornozelo?
Métodos de análise da maturação óssea e estimativa da idade (artigo de 2010)
A mensuração do desenvolvimento físico para determinar a idade óssea pode ser
realizada por meio de estudos radiográficos de diversas regiões do corpo, como
tornozelo, bacia, cotovelo e coluna cervical, embora a radiografia de mão e punho seja a
mais utilizada atualmente.
8. Fixador externo: pino de titânio é mais ou menos flexível? Infecta mais ou

menos?

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RW 6th p 263
R: titânio é menos rigidez (mais flexível) e tem menor taxa de infecção

Traditionally, external fixator pins have been composed of stainless steel, offering
substantial stiffness. Finite element analyses of the near pin bone interface cortex
revealed stress values that were significantly increased by the use of deep threads and
by the use of stainless steel as opposed to titanium pins. Titanium has a much a lower
modulus of elasticity. Because of the better biocompatibility afforded with titanium and
titanium alloys, some investigators prefer the lower pin bone interface stresses, as well
as the better biocompatibility when using titanium, as they feel there is a lower rate of
pin sepsis. This may be due to many factors, including an actual bone ingrowth
phenomenon seen at the pin bone interface.
Among the many different techniques to enhance the pin bone interface fixation,
coating the pins with hydroxyapatite (HA) has been shown to be one of the most
effective. The HA-coated tapered pins improved the strength of fixation at the pin bone
interface, which corresponded to a lower rate of pin tract infection. The HA coating
provides a significant increase in direct bone apposition with a decrease in the fibrous
tissue interposition at the pin bone interface. These advantages provided by HA coating
appear to be clinically more relevant when these pins are used in cancellous bone rather
than in cortical bone. This increase in bone pin purchase also may make these pins more
difficult or painful to remove without anesthesia.
External fixation studies have provided evidence that HA coating reduces the rate of pin
loosening and pin infection. HA-coated pins also performed well in osteoporotic
patients.
O módulo de Young ou módulo de elasticidade é um parâmetro mecânico que

proporciona uma medida da rigidez de um material sólido, que pode ser obtida
da razão entre a tensão exercida e a deformação sofrida pelo
material. Tensão corresponde a uma força ou carga, por unidade de área, aplicada sobre
um material, e deformação é a mudança nas dimensões, por unidade da dimensão
original.
9. Qual sintoma mais comum do mieloma múltiplo?

Campbell 11th 917
R: dor óssea
Bone pain is the most common complaint for patients with multiple myeloma or with a
solitary plasmacytoma. In contrast to most bone tumors, however, other systemic
problems, such as weakness, weight loss, anemia, thrombocytopenia, peripheral
neuropathy (especially with the osteosclerotic type of multiple myeloma),
hypercalcemia, or renal failure, frequently are present at the time of diagnosis of
multiple myeloma. Symptoms usually are of short duration because of the aggressive
nature of the disease. Pathological fractures are relatively common. The spine is the
most common location followed by the ribs and pelvis.
10. Articulação mais acometida no pé na artropatia de Charcot?

R: tarsometatarsal
The tarsometatarsal articulation is the most commonly involved tarsal area and affects
approximately 60% of patients with Charcot arthropathy. The forefoot subluxates or
dislocates laterally, producing an abducted forefoot, secondary hindfoot valgus, plantar
flexion of the talus and hindfoot creating a rocker-bottom deformity, and eventually a
contracted gastrocnemius-soleus muscle
Eichenholz provided a classification and staging system that is useful in Charcot

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arthropathy. It is based on radiographic rather than clinical findings.
Stage 0—unilateral edema, erythema, and associated warmth; no break in skin
integrity; radiographs negative or show local osteoporosis
Stage I—unilateral edema, erythema, and unilateral warmth; radiographs show
osseous destruction, joint dislocation or subluxation
Stage II—decreased local edema, erythema, and associated warmth; radiographs
show coalescence of small fracture fragments and absorption of fine bone debris
Stage III—no or minimal edema, erythema, or increased warmth; radiographs show
consolidation and remodeling of fracture fragments
BRODSKY (classified by the anatomical location): Type 1 involves the

tarsometatarsaljoints, type 2 refers to the triple joint complex, type 3A involves the
tibiotalar joint, and type 3B is a pathological fracture of the calcaneus.
11. Translação posterior dos côndilos femorais: medial são 2mm. E lateral? 1, 7, 14
ou 21?
Campbell 11th p 246
R: 21
Knee motion during normal gait has been studied by many investigators, who have
found it to be much more complex than simple flexion and extension. Knee motion
during gait occurs in flexion and extension, abduction and adduction, and rotation
around the long axis of the limb (Fig. 6-9). Knee flexion, which occurs around a varying
transverse axis (Fig. 6-10), is a function of the articular geometry of the knee and the
ligamentous restraints. Dennis et al. described the flexion axis as varying in a helical
fashion in a normal knee, with an average of 2 mm of posterior translation of the medial
femoral condyle on the tibia during flexion compared with 21 mm of translation of the
lateral femoral condyle.
12. ?
13. Delbet-Colonna: classificar imagem de fratura de quadril na criança. Tipo II
14.?

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15. O Tumor do Hiperparatireoidismo apresenta-se histologicamente de que
forma?
Campbell 11th p 871
R: células gigantes
Primary hyperparathyroidism usually is caused by an adenoma of the parathyroid
glands. Secondary hyperparathyroidismcan occur in patients with chronic renal failure.
When the disease is discovered early, the skeletal change usually is limited to diffuse
demineralization. Only rarely does the change become markedly focal and produce a
“brown tumor,” which resembles a giant cell tumor and is difficult to distinguish from
it. The diagnosis of hyperparathyroidism should be established by determining the
serum calcium, phosphorus, alkaline phosphatase, and parathyroid hormone levels,
rather than by histological examination of a focal lesion. Some microscopic features
suggest hyperparathyroidism, however, rather than giant cell tumor. In
hyperparathyroidism, (1) the giant cells are a little smaller, often occurring in a nodular
arrangement, especially around areas of hemorrhage; (2) the stromal cells are more
spindle-shaped and delicate; and (3) evidence of osseous metaplasia within the stroma is
prominent. The bone surrounding the lesion also should be examined; in
hyperparathyroidism, it may show intense osteoclastic and osteoblastic activity
associated with peritrabecular fibrosis. Patients with hyperparathyroidism usually are
treated by an endocrinologist.
16. Sinal do gancho para desinserção distal do bíceps braquial? Ativa/passiva?

Borda lateral ou medial do tendão?
Não encontrei resposta.
R: ?
Campbell 11th 2772
Ruland et al. described a biceps squeeze test, similar to the Thompson test for Achilles
tendon rupture, for diagnosis of complete distal biceps rupture. The test is done with the
patient seated and the elbow flexed 60 to 80 degrees. This amount of flexion minimizes
tension on the brachialis and helps isolate the biceps to forearm supination. The forearm
is slightly pronated to place tension on the biceps brachii tendon. The examiner stands
on the same side as the extremity being tested. The biceps brachii is squeezed firmly
with both hands, one hand at the distal myotendinous junction and the other around the
muscle belly. As the biceps is squeezed, the muscle belly is drawn away from the
underlying humerus, eliciting an anterior bow of the muscle. Lack of forearm supination
with this maneuver is considered a positive text, indicating rupture of the biceps brachii
tendon or muscle belly. Forearm supination was restored in all patients who had tendon
repair.
17. Músculos inervados por C8?

Canale & Beaty: Campbell's Operative Orthopaedics, 10th Ed., p. 1985.
R: flexores dos dedos

C8 Nerve Root Compression[*]
Sensory Deficit
Ring finger, little finger, and ulnar border of palm
Motor Weakness
Interossei
Finger flexors (variable)
Flexor carpi ulnaris (variable)
Reflex Change
None
* Indicative of C7-T1 disc rupture or other pathological condition at that level.

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18. Myerson II de pé plano por insuficiência do tibial posterior (flexível). Quando
não há carga e o retropé está neutro, qual a atitute: elevação ou diminuição do
arco longitudinal do primeiro raio? Pronação ou supinação do antepé?
R: elevação do arco longitudinal do primeiro raio e supinação do antepé.

Pes planus in children and adults usually is flexible, and on non–weight bearing, a
normal-appearing arch is present (corrected position: a neutral heel and forefoot
position, plantar flexion of the first ray, and restitution of the medial longitudinal arch).
19. Maus tratos: qual o principal local de contusões? Dorso e abdome? Pescoço e
bochecha? Coxa?
RW 6th children p 228
R: Dorso e abdome.
Bruises on the back of the head, neck (17), arms and legs, on the buttocks, abdomen,
cheeks, or genitalia may be suspicious for abuse, although accidental bruises can also
occur in all these locations (9). Accidental bruising of the face, though, is much less
common and should be carefully evaluated. Although nonaccidental bruises often are
concentrated on the trunk and buttocks, they are also commonly present on the head and
proximal extremities.
20. Displasia radial pela classificação de Heikel: a partir de qual grau há

arqueamento da ulna? I, II, III ou IV?
R: II
The currently accepted and most useful classification of congenital radial dysplasias is a
modification of that proposed by Heikel, in which four types are described (Fig. 76-8).
In type I (short distal radius), the distal radial physis is present but is delayed in
appearance, the proximal radial physis is normal, the radius is only slightly shortened,
and the ulna is not bowed. In type II (hypoplastic radius), distal and proximal radial
physes are present but are delayed in appearance, which results in moderate shortening
of the radius and thickening and bowing of the ulna. Type III deformity (partial absence
of the radius) may be proximal, middle, or distal, with absence of the distal third being
most common; the carpus usually is radially deviated and unsupported, and the ulna is
thickened and bowed. The type IV pattern (total absence of the radius) is the most
common, with radial deviation of the carpus, palmar and proximal subluxation, frequent
pseudoarticulation with the radial border of the distal ulna, and a shortened and bowed
ulna.

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21. Fratura do úmero distal em adulto: qual nervo mais lesado? Ulnar, radial,
mediano?
Não achei.
R: ?
RW 6th p 1066
A careful assessment of the neurological status of the hand must also be made. Specific
assessment of the ulnar, median and radial nerve is difficult immediately after trauma
because hand movements may be inhibited by pain, or the elbow may have been placed
in a plaster back-shell. However, it is mandatory to exclude injury to these structures
prior to any therapeutic intervention. The radial and median nerve palsies are more
commonly associated with extension-type transcolumn or bicolumn fractures, whereas
injury to the ulnar nerve is more commonly associated with flexion injuries and medial
epicondyle fractures.
22. Qual significado do ball-sign para fratura do tornozelo no adulto? Lesão da

sidesmose, lesão do deltoide ou encurtamento da fíbula?
RW 7th p 1978
R: encurtamento da fíbula.

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23. Perthes: quais movimentos estão acometidos? Adução ou abdução? RI ou RE?
Tachdjian 4th p 787
R: Abdução e rotação interna.

As the disorder progresses, findings on the clinical examination may be significantly
different. Patients with mild disease may experience only slight loss at the extreme
ranges of motion and may rapidly regain normal mobility of the leg. Those with more
severe disease have greater loss of motion, particularly of abduction and internal
rotation. When the hip is flexed, it may go into obligatory external rotation. In severe
cases adduction contractures develop and the child may lose all rotation of the hip. The
range of flexion and extension, however, is seldom affected.
24. Fibroma não ossificante: qual localização típica? Fêmur distal ou tíbia
proximal?
Campbell 11th 862
R: Fêmur distal ou tíbia proximal?

Nonossifying fibromas (also known as metaphyseal fibrous defects, fibrous cortical
defects, and fibroxanthomas) are common developmental abnormalities and are
believed to occur in 35% of children. Usually they are found incidentally. Generally,
these lesions occur in the metaphyseal region of long bones in individuals 2 to 20 years
old. Although any bone may be involved, approximately 40% are found in the distal
femur, 40% in the tibia, and 10% in the fibula.
25. Sinostose radio-ulnar: mais comum proximal ou distal? Acesso único ou duplo?
R: Proximal e acesso único

An incidence of about 2% was reported; and it is suggested that the incidence is higher
in type IV Monteggia fractures involving both bones of the forearm together with a
radial head dislocation. Another study reported an incidence of 6.6% in a series of 167
patients, more than half of which were fractures of both bones of the forearm (94). In
patients with co-existing head trauma, the incidence of radio-ulnar synostosis has been
reported as high as 18% in a mixed group of nonoperative and operatively treated
patients. The most important risk factors for the development of radio-ulnar synostosis
include high-energy trauma open fractures, infection, head injuries, and where internal
fixation is delayed by several weeks. Surgical factors include narrowing of the
interosseous space by imperfect reduction, bone grafting, and overlong screws that
transgress the interosseous space or may impinge in the proximal third of the forearm.
26. C7: qual déficit neurológico?

Canale & Beaty: Campbell's Operative Orthopaedics, 10th Ed., p. 1985.
R: Hiporreflexia tricipital.
C7 Nerve Root Compression[*]
Sensory Deficit
Middle finger (variable because of overlap)
Motor Weakness
Triceps
Wrist flexors (flexor carpi radialis)
Finger extensors (variable)
Reflex Change

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Triceps
27. Órtese para lesão do nervo ulnar? Flexão ou extensão da interfalangiana ou da

metacarpofalangiana?
Pardini lesões traumáticas da mão 4ed p 371
R: Flexão da metacarpofalangiana
Garra ulnar: hiperextensão da MCF e hiperflexão das interfalangianas. Objetivo da
órtese pós-operatória: bloqueio da hiperextensão da metacarpofalangiana.
28. Qual deformidades podem ocasionar in-toening: aumento da retroversão ou

anteversão femoral?
Não achei
R: Aumento da anteversão femoral e da torção interna da perna?
29. O que são os nódulos de Garrod na doença de Dupuytren?

R: tumoração no dorso da interfalangiana proximal

Ectopic deposits of Dupuytren disease may occur in a variety of areas (Fig. 72-1).
Approximately 5% of patients with Dupuytren contractures have similar lesions in the
medial plantar fascia of one or both feet, known as Ledderhose disease, and 3% of
patients have plastic induration of the penis, known as Peyronie disease. “Knuckle
pads” are common on the dorsum of the proximal interphalangeal joints. Patients with
these associated findings are considered to have a Dupuytren diathesis and are prone to
progressive and recurrent disease
30. Artrite séptica bilateral acomete qual articulação mais comumente? Quadril,
joelho, ombro?
Campbell 11th p 733
R: quadril
Acute septic arthritis of the hip is a more serious disease in children than in adults, and
severe complications are much more common in children. In many cases, infection
begins first in the metaphysis or epiphysis and is carried into the joint. As a result of the

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peculiar circulation of the femoral head, a septic hip places the femoral head at high risk
for osteonecrosis. Epiphyseal separation also has been reported as a complication of
septic arthritis of the hip in children. If a septic hip goes undiagnosed in an infant, a
pathological dislocation may occur. After an infected hip in an infant or child has been
surgically drained, the hip should be supported in abduction to reduce the risk of
pathological dislocation. Bilateral septic arthritis is seen more often in the hip than in
other joints and occasionally is associated with spinal infection.
31. O que é fratura de Segond?

R: Fratura da margem lateral da tíbia
32. Instabilidade póstero lateral: o eixo sagital desloca-se para qual região da tíbia
proximal? Anterolateral, anteromedial, posterolateral ou posteromedial?
R: posteromedial
Alterations in the vertical and transverse axes can occur with disruptions and
derangements of the knee joint. When the medial ligaments are disrupted, the vertical
axis of rotation shifts laterally, and vice versa. This is discussed in greater detail in the
section on simple and combined instabilities of the knee. Because of the eccentricity of
the femoral condyles, the transverse axis of rotation constantly changes position (instant
center of rotation) as the knee progresses from extension into flexion.
33. Ressalto no quadril é mais comum em mulheres ou homens, jovens ou idosos?

Não achei no Campbell.

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R: mulheres jovens?
34. Imagem de manobra de redução de quadril: Allis, Stimson?
R: Stimson
35. Artropatia do manguito rotator: qual a característica radiográfica? Esclerose

subacromial, osteófito inferior?
R: Esclerose subacromial
End-stage rotator cuff disease leads to an entity known as rotator cuff arthropathy.
Normal humeral head depression of the supraspinatus is lost, and the unopposed deltoid
pull leads to shearing forces across the glenoid. Articular cartilage is poorly suited to
resist shearing-type forces, and degenerative changes ensue. Neer also postulated that
nutritional factors contributed to the process owing to loss of fluid pressure and the
accompanying reduction in the quality of the chemical content of the synovial fluid
leading to cartilage and bone atrophy. Radiographic findings include the sourcil sign
(erosion of the inferior acromial surface as the humeral head “articulates” against the
undersurface of the acromion), inferior humeral head osteophytes, and loss of
glenohumeral joint space
36. Cobb 35, 14 anos, menarca há dois anos: alta? Observação cor x seriado, colete
de Milwaukee por dois anos ou artrodese?
R: Observação
In general, young patients with mild curves of less than 20 degrees can be examined
every 6 to 12 months. Adolescents with larger degrees of curvature should be examined
every 3 to 4 months. Skeletally mature patients with curves of less than 20 degrees
generally do not require further evaluation. A curve of more than 20 degrees in a patient
who has not reached skeletal maturity demands more frequent examination, usually
every 3 to 4 months, with standing posteroanterior radiographs. If progression of the
curve (an increase of 5 degrees during 6 months) beyond 25 degrees is noted, orthotic

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treatment is considered. For curves of 30 to 40 degrees in a skeletally immature patient,
orthotic treatment is recommended at the initial evaluation. Curves of 30 to 40 degrees
in skeletally mature patients generally do not require treatment, but because studies
indicate a potential for progression in adult life, these patients should be observed with
yearly standing posteroanterior radiographs for 2 to 3 years after skeletal maturity, then
every 5 years throughout life.
37. Fratura de Monteggia: qual tipo com pior resultado no adulto? I, II, II, IV?
RW 7th p 894
R: II
However, modern methods of fixation have improved the outcome of management of
these injuries. In a series of 48 adult patients with Monteggia injuries treated with open
reduction and rigid internal fixation, there were 83% excellent or good results, though
this was achieved after a number of reoperations and reconstructive surgery. The
majority of the poorer results resulted from Bado type 2 injuries; all had a radial head
fracture and half of the cases had a coronoid fracture. The authors correlated Bado type
2 fractures, Jupiter type 2a fractures, radial head fracture, coronoid fracture, and
complications requiring reoperation with a poorer prognosis. Associated ulnohumeral
instability has also been noted as a poor prognostic factor.
38. Quais parâmetros usados no ISIS para ombro? Idade da cirurgia ou da

luxação? Sexo ou atividade esportiva?
R: idade da cirurgia e atividade esportiva
39. Qual pior impacto funcional para o paciente após fratura de rádio distal?
Encurtamento do rádio, desvio radial?
Rw 7th p 838
R: incongruência articular, mas não lembro se havia essa opção, lembro que tinha
encurtamento do rádio.
Radiocarpal articular congruity remains the most clinically significant radiographic
parameter in younger patients with regard to both functional outcome and future
degenerative changes. Adams found that positive ulnar variance resulted in the most
significant changes in the kinematics of the radioulnar joint when compared with loss of
radial inclination and palmar tilt. Clinical studies have also indicated a strong
correlation between radial length and loss of strength.

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40. Peça anatômica de quadril em plano axial ao nível do forame obturatório: qual
estrutura apontada? Obturador externo, pectíneo, iliopsoas?
R: Obturador externo
Pedia o número 3.
41. Qual localização da dor na perna no pós-operatório de haste de tíbia? No local

de inserção da haste, no local de inserção dos parafusos proximais ou no local de
inserção dos parafusos distais?
RW 7th p 1902
R: tibial shaft fractures they found that 57% of patients developed anterior knee pain
(level of evidence: 4). They also found no significant correlation between proximal
protrusion of the nail and knee pain, but they suggested that there might be an
association with a patellar tendon splitting approach as compared to a parapatellar
insertion with a higher number of patients (77%) having pain with the patellar tendon
splitting approach as compared to the paratendinous approach (50%). They found that
80% of their patients required nail removal and that the majority had their pain either
completely or partially relieved.
42. ?
43. Raquitismo nutricional: FA e Cálcio elevados ou normais?

Tachdjian 4th p 1917
R: Cálcio normal e FA elevada
Table 32-1 -- Biochemical Abnormalities in Rickets

Biochemical
Abnormality
1, 25
25 (OH) (OH) 2
Alkaline Vitamin Vitamin
Type of Rickets Calcium Phosphate Phosphatase PTH D D
Nutritional N1 N1↓ ↑ ↑ ↓↓ ↓

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Vitamin D–resistant N1 ↓ ↑ N1 N1 N1
(XLH RTA,
Fanconi's, oncogenic
Vitamin D–dependent ↓ ↓ ↑ ↑ ↑↑ ↓↓
type I (inability to
hydroxylate)
Vitamin D–dependent ↓ ↓ ↑ ↑ N1↑↑ ↑↑↑↑
type II (receptor
insensitivity)
Renal osteodystrophy N1↓ ↑ ↑ ↑↑ N1 ↓↓
N1, normal; PTH, parathyroid hormone; RTA, renal tubular acidosis; XLH, X-linked
hypophosphatemia.
44. Qual desvio do fragmento lateral da fratura da diáfise da clavícula? Superior

ou inferior; rotação anterior ou posterior?
RW 7th p 1109
R: translação anterior e inferior

Muscular and gravitational forces acting on the clavicle with resultant deformity. The
distal fragment is translated anteriorly, medially, and inferiorly and rotated anteriorly.
This results in the scapula being protracted.
45. Definição de choque medular: lesão temporária ou definitiva? Há abolição ou

preservação dos reflexos?
Campbel 11th p 1763
R: temporária e abolição.
Although spinal shock generally resolves within 24 hours, it may last longer. A positive
bulbocavernosus reflex (Fig. 35-4) or return of the anal wink reflex (Fig. 35-5) indicates
the end of spinal shock. If no motor or sensory function below the level of injury can be
documented when spinal shock ends, a complete spinal cord injury is present, and the

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prognosis is poor for recovery of distal motor or sensory function.
46. Pé talo vertical: qual estrutura está contraída? Tibial posterior, tibial anterior,
flexor longo do hálux ou fáscia plantar?
R: tibial anterior
Pathologic soft tissue changes in an infant with congenital vertical talus who died 8
hours after birth. A, Lateral view. Note the rocker-bottom foot with dorsiflexion of the
forefoot (A) and equinus deformity of the heel. The apex angulation of the lateral
column is at the calcaneonavicular joint. The calcaneus (B) is displaced laterally under
the talus and lies in close proximity to the distal end of the fibula (C). The contracted
triceps surae (F) is holding the calcaneus in plantar flexion. The peroneus longus (D)
and peroneus tertius (E) are shortened. B, Medial view. The anterior tibial (G) and
extensor hallucis longus (H) muscles are shortened. (The extensor digitorum longus is
also contracted, but it is not apparent in this photograph.) The triceps surae muscle (F) is
shortened. These musculotendinous contractures are secondary obstacles to anatomic
alignment of the talocalcaneonavicular joint.
47. Imagem radiológica em AP e perfil de pé na criança: PTC, metatarso aduto, pé

cavo?
R: PTC

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48. Classificação de Litchman para Kienbock: qual tratamento para tipo IIIB?
Revascularização, curetagem do rádio, encurtamento do rádio ou ressecção da
fileira proximal do carpo?
R: ressecção da fileira proximal do carpo
Numerous surgical procedures have been described for Kienböck disease. Joint
“leveling” procedures include ulnar lengthening and radial shortening and usually are
indicated for Lichtman stage I through IIIA Kienböck disease, with an ulnar-minus
variation and without degenerative changes in the radiolunate or capitolunate joints.
Wedge osteotomies have been used to decrease the load on the lunate by decreasing the
radioulnar inclination of the distal radius. Lunate revascularization using a variety of
pedicled bone grafts has been effective in preserving the lunate architecture. These
revascularization procedures usually require protection of the lunate with pinning of the
scaphocapitate or scaphotrapeziotrapezoid joint or with an external fixator. Excision of
the lunate can give short-term relief. Prosthetic lunate replacement also may provide
relief. Limited intercarpal fusions can prevent proximal carpal migration after lunate
excision and can help decrease pressure on lunate prostheses. When secondary arthritic
changes have developed throughout the wrist (stage IV), treatment usually is proximal
carpal row resection or wrist arthrodesis.
49. Fratura de úmero proximal no idoso? Mulher ou homem? Lado dominante ou

não?
RW 7th p 1040
R: mulher, lado não dominante

There are marked gender differences, with approximately 70% to 80% of fractures
occurring in women. Depleted protective neuromuscular responses, because of a
delayed reaction time, cognitive impairment, neuromuscular disorders, impaired
balance, or acute intoxication, increase the risk of a fall directly onto the shoulder. The
nondominant arm is also affected in up to three quarters of cases, suggesting an
association with reduced strength and neuromuscular coordination.
50. Principal causa de lesão osteocondral na região femoral lateral? Luxação de

patela, lesão do colateral lateral ou do LCP?
R: luxação de patela
Osteochondral fractures of the lateral femoral condyle to be more common in
adolescent boys and suggested that they often were caused by dislocation of the patella,
which shears off a fragment of the condyle in much the same way as osteochondral
fractures of the patella are produced. Osteochondral fractures of the femoral condyles
also can be caused by a direct blow or twisting movement on a weight bearing flexed
knee. The patella is momentarily subluxated over the lateral condyle with enough force
to score the articular surfaces of the patella and the femur. The medial border of the
patella is caught against the prominent edge of the femoral condyle. As the quadriceps
muscle snaps the patella back into place, the edge of the femoral condyle shears an
osteochondral fragment from the inferior and medial edge of the patella.
Osteochondral fractures of the knee occur most commonly in adolescents and young
adults, often with a history of patellar dislocation or a twisting injury to the knee
associated with a painful snap. A hemarthrosis is present in acute injuries, and medial
tenderness indicative of a medial retinacular tear is common. Osteochondral fractures of
the patella occur in 5% of acute patellar dislocations in adolescents. Prompt diagnosis
and treatment of osteochondral fractures of the knee are necessary to obtain optimal
results. Some patients report locking or a sensation of a loose body within the knee
joint. In others, the diagnosis is more subtle.

Página 16 de 34
51. ?
52. Qual principal localização de TB óssea no membro superior? Articulação

metacarpofalângica, punho, cotovelo ou ombro?
Campbell 11th p 762
R: cotovelo
Although tuberculosis occurs more frequently in the elbow than in other upper
extremity joints, the elbow is involved in only 5% of patients with osseous disease. The
proximal segment of the ulna (olecranon) is more typically affected, which can result in
a progressive degenerative process and a significant elbow flexion contracture.
Functional positioning becomes paramount in such cases. Tuberculosis of the elbow
often can be treated satisfactorily by rest and chemotherapy. Aspiration of an abscess or
evacuation of a lesion in the olecranon may be necessary. Occasionally, partial
synovectomy and curettage, arthrodesis, or excision of the elbow joint may be indicated.
53. Síndrome compartimental crônica da perna: quais principais compartimentos

e qual índice de bilateralidade? Anterior, lateral ou posterior profundo? 50 ou
75%?
R: anterior e posterior profunda; bilateral em 75%

Chronic Exertional Compartment Syndrome : A typical patient with CECS is a
competitive runner, 20 to 30 years old, who describes exercise-induced pain and a
feeling of tightness that begins after 20 to 30 minutes of running. The pain usually
resolves within 15 to 30 minutes of cessation of exercise. Paresthesias of the nerves
running through the involved compartment often are reported. Physical examination
may reveal tenderness over the musculature of the involved compartment. Detmer et al.
reported bilateral involvement in 82% of patients. Fascial hernias have been reported to
have a definite association with the development of exertional compartment symptoms.
Fronek et al. found fascial hernias in 39% of their patients with anterolateral
compartment syndrome, and Schepsis et al. noted that approximately 15% to 20% of his
patients with CECS had fascial hernias, most often patients with anterior or lateral
compartment syndrome. More often, physical examination is normal. Differential
diagnosis of anterior compartment syndrome includes periostitis (medial tibial
syndrome) and entrapment of the superficial peroneal nerve. Deep posterior
compartment syndrome must be differentiated from periostitis, tendinitis of the
posterior tibial tendon, stress fracture of the tibia, and intermittent claudication caused
by anomalous insertion of the medial head of the gastrocnemius-soleus, causing
compression of the popliteal artery.
54. Qual apresentação típica da fratura tipo burst da coluna? alargamento dos
processos espinhosos no perfil ou alargamento dos pedículos no AP?
RW 7th p 1378
R: alargamento dos pedículos no AP

With more significantaxial forces, the fracture line may extend posteriorly through the
entire body, which is characteristic of a burst injury. By definition, these fractures are
more unstable than compression injuries and frequently bring about compression of the
neural elements secondary to the retropulsion of bony fragments into the spinal canal.
Although in the past burst fractures were attributed primarily to axial loading of the
spine, the authors of a recent in vitro biomechanical study reported that at least some
degree of extension was also required to reproduce the interpedicular widening and
canal compromise that are regularly observed in conjunction with these injuries. In

Página 17 de 34
addition to displaying any irregularities in coronal alignment, anteroposterior (AP)
views may reveal interpedicular widening that occurs when the fragments of burst
fractures are laterally displaced or an increased interspinous process distance
characteristic of damage to the posterior ligamentous complex (PLC).
55. Quando está indicado a cirurgia na fratura por estrese da tíbia: longitudinal,
transversa anterior, posteromedial ou posterolateral?
RW 7th p 524
R: transversa anterior
The majority of tibial stress fractures are posteromedial compression injuries and occur
usually in the proximal or distal thirds. When a fracture has developed, a transverse
orientation is typical, proximal or distal thirds. When a fracture has developed, a
transverse orientation is typical, but longitudinal stress fractures also are reported. These
fractures respond well to cessation of the repetitive loading activity, which almost
always is distance running, along with complete leg rest using crutches until the pain
subsides. Initial conservative treatment requires prolonged modified rest, with or
without cast or brace immobilization. However, even over 4 to 6 months, many of these
fractures with chronic changes and anterior fissures or cracks will remain symptomatic
and nonunited. Transverse drilling of the nonunion sites reportedly stimulates healing
and speeds time to return to activity. Reamed intramedullary nailing works well for
recalcitrant cases and now has some support as the initial treatment of choice for the
anterior cortical stress fracture nonunion.
56. Principal sintoma clínico do gatilho está em qual articulação? Flexão ou

extensão da interfalangiana proximal ou metacarpofalangiana?
Campbell 11th 4300
R: extensão da interfalangiana proximal

Trigger finger: tenosing tenosynovitis, leading to inability to extend the flexed digit
(“triggering”) usually is seen in individuals older than 45 years of age. When associated
with a collagen disease, several fingers may be involved—the long and ring fingers
most often. Patients may note a lump or knot in the palm. The lump may be the
thickened area in the first annular part of the flexor sheath or a nodule or fusiform
swelling of the flexor tendon just distal to it. Occasionally, a partially lacerated flexor
tendon at this level heals with a nodule sufficiently large to cause triggering. Local
tenderness may be present, but is not a prominent complaint. Pressure accentuates the
snapping or triggering of the distal joints. Particularly in the thumb, the constriction is
opposite the metacarpophalangeal joint, although the interphalangeal joint is the one
that appears to lock or snap.
57. Fratura do calcâneo: quais planos na TC é melhor para visualizar calcâneo

cuboide, subtalar e tuberosidade posterior?
RW 7th p 2071
R: axial, coronal e sagital

CT scanning has vastly improved the understanding of calcaneal fractures and has
subsequently allowed for consistent analysis of treatment results.* CT images are
obtained in the axial, 30-degree semicoronal, and sagittal planes. The coronal views
provide information about the articular surface of the posterior facet, the sustentaculum,
the overall shape of the heel, and the position of the peroneal and flexor hallucis
tendons. The axial views reveal information about the calcaneocuboid joint, the
anteroinferior aspect of the posterior facet, and the sustentaculum. Sagittal
reconstruction views provide additional information as to the posterior facet, the
calcaneal tuberosity, and the anterior process

Página 18 de 34
58. ?
59. Principal causa de revisão de ATQ em menos de 6 meses da cirurgia? Luxação,

Soltura séptica, asséptica ou fratura?
Campbell 11th p 401
R: luxação
Most dislocations occur within the first 3 months after surgery. The dislocation often is
precipitated by malpositioning of the hip at a time when the patient has not yet
recovered muscle control and strength. Late dislocations can be caused by progressive
improvement in motion after surgery. Impingement caused by component malposition
or retained osteophytes may not become manifest until extremes of flexion and
adduction are possible. Late dislocations are more likely to become recurrent and
require surgical intervention.
60. O que fazer caso o paciente preencha os critérios de Mirels? Curetagem,

osteossíntese profilática ou endoprótese?
Campbell 11th p 923
R: osteossíntese profilática.
Mirels devised a scoring system that evaluates the risk of pathological fracture based on
the site, size, and lytic or blastic nature of the lesion. According to this system,
prophylactic internal fixation should be considered for any patient with a score of 8 or
greater. Prophylactic internal fixation of an impending fracture is technically easier than
fixation of an actual pathological fracture. Patient morbidity is decreased with
prophylactic fixation compared with fixation after the fracture.
61. Qual principal estabilizador estático da articulação Glenoumeral? Ligamento

coracoumeral, ligamento glenoumeral superior, médio ou inferior?
R: ligamento glenoumeral inferior

The superior glenohumeral ligament attaches to the glenoid rim near the apex of the
labrum conjoined with the long head of the biceps. On the humerus, it is attached to the
anterior aspect of the anatomical neck of the humerus. The superior glenohumeral
ligament is the primary restraint to inferior humeral subluxation in 0 degrees of
abduction and is the primary stabilizer to anterior and posterior stress at 0 degrees of
abduction. Harryman et al. and Warren have shown that tightening of the rotator interval
(which includes the superior glenohumeral ligament) decreases posterior and inferior
translation. The middle glenohumeral ligament has a wide attachment extending from
the superior glenohumeral ligament along the anterior margin of the glenoid down as far
as the junction of the middle and inferior thirds of the glenoid rim. On the humerus, it
also is attached to the anterior aspect of the anatomical neck. The middle glenohumeral
ligament limits external rotation when the arm is in the lower and middle ranges of
abduction, but has little effect when the arm is in 90 degrees of abduction. The inferior
glenohumeral ligament attaches to the glenoid margin from the 2-o'clock to 3-o'clock
positions anteriorly to the 8-o'clock to 9-o'clock positions posteriorly. The humeral
attachment is below the level of the horizontally oriented physis into the inferior aspect
of the anatomical and surgical neck of the humerus. The anterosuperior edge of this
ligament usually is quite thickened. With external rotation, the hammock slides
anteriorly and superiorly. The anterior band tightens, and the posterior band fans out.
With internal rotation, the opposite occurs. The anteroinferior glenohumeral ligament

Página 19 de 34
complex is the main stabilizer to anterior and posterior stresses when the shoulder is
abducted 45 degrees or more. The ligament provides a restraint at the extremes of
motion and assists in the rollback of the humeral head in the glenoid.
62. Tipo III de Levine para enforcado (C2 C3): artrodese C1-C2 ou C2-C3?
R: Artrodese C2-C3
Type III injuries combine a bipedicular fracture with posterior facet injuries. They
usually have severe angulation and translation of the neural arch fracture and an
associated unilateral or bilateral facet dislocation at C2-3. Type III injuries are the only
type of hangman's fracture that commonly require surgical stabilization. These fractures
frequently are associated with neurological deficits. Open reduction and internal
fixation usually are required because of inability to obtain or maintain reduction of the
C2-3 facet dislocation. Because the lamina and spinous process of C2 are a free-floating
fragment, bilateral oblique wiring of C2-3 is necessary for stable reduction. After
posterior cervical fusion at the C2-3 level, halo vest immobilization for 3 months is
necessary for the bipedicular fracture and for consolidation of the fusion mass.
63. Quais músculos inervados pelo interósseo anterior?
R: Flexor longo do polegar

Deep Flexors Anterior Interosseous N: Flexor digitorum profundus [digits 2, 3], Flexor
pollicis longus [FPL], Pronator Quadratus [PQ]
64. Após luxação da patela, em que quadrante ocorre a fratura osteocondral?

Superior, inferior? Medial ou lateral?
RW 7th p 1776
R: Inferomedial
Acute traumatic patellar dislocations occur with an average annual incidence of 5.8 per
100,000, increasing to 29 per 100,000 in the 10- to 17-year age group.102 Lateral
patellar dislocations occur most commonly and conservative treatment is usually
recommended. The majority of patients experience no further instability, but the
reported recurrence rates after conservative treatment range from 15% to 44%.
Osteochondral fractures at the medial inferior edge of the patella are highly suggestive
of this injury pattern.
65. Perda cutânea na polpa digital de dedos longos: quando está indicado enxerto
de pele total? Lesão < ou > que 1 cm? Com ou sem exposição óssea?
R: lesão >1cm sem exposição óssea

If skin is lost, and no deep structures (nerves, tendons, joints, or cortical bone) have
been exposed, it should be replaced immediately with a split-thickness graft or
occasionally with a full-thickness graft. When a skin defect leaves deep structures
exposed, a split-thickness or full-thickness skin graft is insufficient coverage for nerves,
tendons, and cortical bone. Fingertip injuries with only skin loss less than 1 cm square
may be treated satisfactorily with healing by secondary intention. If the defect is larger
without exposed bone, a full-thickness skin graft provides good coverage and the
potential for return of some sensation.

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66. Imagem radiográfica e tomográfica de fratura de bacia: classificar segundo
Tile e Young Burges.
R: B1 e CAP II.
67. Fatores de risco para fratura avulsão da TAT em crianças? Encurtamento ou

alongamento dos isquiotibiais? Patela alta ou baixa?
não achei
R: Encurtamento dos isquiotibiais e patela alta?
68. ?
69. Qual tratamento para o fibrohistiocitoma maligno do osso? QT neo + Cirurgia

+ QT adjuvante, só cirurgia, cirurgia + QT adjuvante?
Campbell 11th p 917
R: QT neoadjuvante, Cirurgia e QT adjuvante

At most institutions, the treatment of malignant fibrous histiocytoma of bone and
fibrosarcoma of bone is similar to the treatment of osteosarcoma. Most patients with
high-grade lesions are treated with neoadjuvant chemotherapy, followed by surgery
(wide resection or wide amputation) and adjuvant chemotherapy. Compared with
osteosarcoma, however, malignant fibrous histiocytoma may be more radiosensitive.
70. ?
71. Qual indicação de solicitar radiografia para dor lombar aguda? Paciente com
história familiar de AR, parestesia no membro superior, pelo menos duas visitas ao
médico em 30 dias.
R: pelo menos duas visitas ao médico em menos 30 dias.

Selective Indications for Radiography in Acute Low Back Pain
Age >50 years
Significant trauma
Neuromuscular deficits
Unexplained weight loss (10 lb in 6 months)
Suspicion of ankylosing spondylitis
Drug or alcohol abuse
History of cancer
Use of corticosteroids
Temperature ≥37.8°C (≥100°F)
Recent visit (≤1 month) for same problem and no improvement
Patient seeking compensation for back pain

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72. Qual tipo de PC cursa com acometimento leve dos MMSS e pior nos MMII?
Tetra, hemi, tri ou diplégico?
R: diplégico
• Lower extremities more involved than upper extremities
Diplegia • Fine-motor/sensory abnormalities in upper extremity
73. Paciente com 50 anos, artrose medial e varo de 22º. Qual tratamento?
Artroplastia total, unicompartimentar, osteotomia tibial ou femoral?
R: osteotomia tibial de cunha medial de adição

The indications for proximal tibial osteotomy are (1) pain and disability resulting from
osteoarthritis that significantly interfere with high-demand employment or recreation,
(2) evidence on weight bearing radiographs of degenerative arthritis that is confined to
one compartment with a corresponding varus or valgus deformity, (3) the ability of the
patient to use crutches after the operation and the possession of sufficient muscle
strength and motivation to carry out a rehabilitation program, and (4) good vascular
status without serious arterial insufficiency or large varicosities. Contraindications to a
proximal tibial osteotomy are (1) narrowing of lateral compartment cartilage space, (2)
lateral tibial subluxation of more than 1 cm, (3) medial compartment tibial bone loss of
more than 2 or 3 mm, (4) flexion contracture of more than 15 degrees, (5) knee flexion
of less than 90 degrees, (6) more than 20 degrees of correction needed, and (7)
rheumatoid arthritis.
74. Qual principal articulação acometida pela psoríase na mão?

R: interfalangiana.
An estimated 25% of patients with psoriatic arthritis have polyarthritis similar to
rheumatoid arthritis; 5% to 10% have distal interphalangeal joint involvement. About
15% to 20% develop the skin rash typical of psoriasis after they develop the arthritis.
Almost 95% of patients with psoriatic arthritis have asymmetrical peripheral joint
involvement. Fusiform swelling of the entire digit may occur. Uniquely, the nails may
separate from the nail bed and have a white, flaking discoloration near their distal
borders; they also may be ridged. Nalebuff observed that fingernail changes, the most
common of which is pitting, is said to be present in about 15% of patients with joint
involvement . Radiographic changes in psoriatic arthritis of the hand include erosion of
terminal phalangeal tufts (acroosteolysis), tapering of the phalanges and metacarpals,
cupping of the proximal ends of phalanges and metacarpals (“pencil-in-cup” deformity),
severe destruction or ankylosis of isolated small joints, and a predilection for the
interphalangeal joints with sparing of the metacarpophalangeal joints. Contractures of
the proximal interphalangeal joints most often require surgical treatment, usually
arthrodesis.
75. Qual desses itens é causa de metatarsalgia primária? Hálux rigidus, neuroma
de Morton, doença de Freiberg ou braquimetatarsalgia?
R: Braquimetatarsalgia
Brachymetatarsia is a condition in which one of the metatarsals is abnormally short. The

Página 22 de 34
fourth ray is most commonly involved, followed by the first and fifth rays. The
shortening may be congenital or caused by premature physeal closure resulting from
trauma, surgery, infection, or pathological conditions
76. No tratamento da fratura diafisária do úmero com acesso anterolateral, qual a

principal complicação? Infecção, refratura, pseudoartrose ou lesão do nervo
radial?
R: lesão do nervo radial

The advantages of this approach include the favorable position of the patient, the ability
to extend the incision proximally to deal with associated shoulder pathology or a
proximal extension of the fracture, and identification of the radial nerve at the mid part
or distally. Disadvantages include technical difficulty in applying a plate distally along
the (thin) lateral supracondylar ridge, the lack of access to any distal medial column
pathology, and the noticeable scar that result.
The most frequently reported complication after plate fixation of humeral shaft fractures
is radial nerve palsy. When using an anterolateral (brachialis-splitting) approach, it is
essential to ensure that the nerve is not under the implant during plate application to
avoid iatrogenic radial nerve injury. Posteriorly, soft-tissue tethers on the radial nerve
can lead to iatrogenic injury. This can be remedied by adequate soft-tissue release off
the radial nerve. Infection is reported to occur after 1% to 2% of closed humeral
fractures and 5% of open fractures. Refractures occur in approximately 1% of patients.
Nonunion of humeral shaft fractures is infrequent.
77. Titânio vs aço: qual é mais resistente? Quantas vezes mais? Duas ou quatro
vezes mais resistente? Duas ou quatro vezes menos resistente?
Não achei
R: ?
Finite element analyses of the near pin bone interface cortex revealed stress values that
were significantly increased by the use of deep threads and by the use of stainless steel
as opposed to titanium pins. Titanium has a much a lower modulus of elasticity.
Because of the better biocompatibility afforded with titanium and titanium alloys, some
investigators prefer the lower pin bone interface stresses, as well as the better
biocompatibility when using titanium
78. Qual fratura do tálus mais comum na criança: colo, cabeça, corpo ou processo
lateral?
R: colo
Fractures of the talus are very rare in children and adolescents. Talus fractures most
commonly occur through the neck and occasionally the body. Although rare, talus
fractures are important to recognize due to the possible complication of avascular
necrosis (AVN). This can occur due to the precarious blood supply and fracture patterns.
In children, AVN seems more prevalent in innocuous fractures when compared to adults
with similar injuries. The majority of talus fractures in children can be treated with cast
immobilization whereas displaced fractures in adolescents need to be treated operatively
similar to an adult fracture.
79. ?

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80. ?
81. Na criança, qual mecanismo de ação da fratura do colo do rádio com fratura
em galho verde do olecrano? Supinação ou pronação, valgo ou varo?
R: pronação e valgo?
Letts et al (25) devised a classification of Monteggia fractures in children based on both
the direction of the radial head dislocation and the type of ulnar fracture. The Bado type
I class was subdivided into three subtypes. Letts type A is anterior bowing of the ulna
due to plastic deformation with anterior dislocation of the radial head. Type B includes a
greenstick fracture of the ulna, and type C has a complete ulnar fracture. Letts types D
and E correspond, respectively, to Bado types II and III.
Monteggia fractures are produced by various mechanisms (by Bado classification):

Type I: Forced pronation of the forearm
Type II: Axial loading of the forearm with a flexed elbow
Type III: Forced abduction of the elbow
Type IV: Type I mechanism in which the radial shaft additionally fails
82. Qual principal estabilizador da articulação do cotovelo em 90º de flexão?

Cabeça do rádio, cápsula, colateral medial ou lateral?
R: ligamento colateral medial

The medial collateral ligament of the elbow is a well-developed ligament. Tullos et al.
divided it into three portions. In contrast to the lateral collateral ligament, the medial
collateral ligament plays an important role in valgus stability. Valgus stability is divided
equally among the medial collateral ligament, the anterior capsule, and the bony
articulation with the elbow in full extension. At 90 degrees of flexion, the medial
collateral ligament provides 55% of the stability to valgus stress. Tullos et al.
emphasized that the anterior oblique portion is the most important part of the medial
collateral ligament. Studies by Schwab et al., Norwood et al., and Morrey and An
indicate that the primary soft-tissue stabilizer of the elbow seems to be the medial
collateral ligament, with respect to valgus and distraction stress. The radial collateral
ligament is primarily effective in extension to resist varus stress
83. Qual estrutura, além das bandas laterais, provocam a deformidade em

extensão da falange distal no dedo em botoeira? Placa volar, retinacular oblíquo,
capuz extensor?
R: ligamento retinacular oblíquo

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84. Qual primeira manifestação da capsulite adesiva: perda da RI, RE, Flexão ou
extensão?
R: Rotação interna
We have noted that internal rotation frequently is lost initially, followed by loss of
flexion and external rotation. Most often our patients can internally rotate only to the
sacrum, have 50% loss of external rotation, and have less than 90 degrees of abduction.
85. Imagem radiológica de Blount à D. pedia o diagnóstico. Opções: Fisiológico,

escorbuto, displasia epifisária.
R: Blount
86. Quais melhores indicações para haste retrógrada na fratura de fêmur?

Obesidade mórbida, joelho flutuante, fratura ipsilateral do colo, fratura da pelve?
RW 7th p 1684
R: Obesidade mórbida, joelho flutuante e fratura ipsilateral do colo femoral.

TABLE 50-6 Indications for Retrograde Nails
Relative Indications
Multiply injured patients or polytrauma
Bilateral femur fractures
Morbid obesity
Distal metaphyseal fractures
Pregnancy
Associated vascular injury
Associated spine fracture
Ipsilateral femoral neck fracture
Ipsilateral acetabular fracture
Ipsilateral patella fracture
Ipsilateral tibia fracture
Ipsilateral through knee amputation
Relative Contraindications
Subtrochanteric fracture
Limited knee motion (if starting point inaccessible)
Patellar baja
Open fractures

Página 25 de 34
87. Grau I de Singh? Presença ou ausência das trabéculas de compressão e tensão?
R: presença de trabéculas de compressão e ausência de trabéculas de tensão.
88. Na dor regional complexa da mão após fratura de rádio distal, qual deve ser o
tratamento complementar? Vitamina A, C, D ou E?
Rw 7th p 874
R: Vitamina C
Complex regional pain syndrome (CRPS) occurs in its early stages in up to 40% of
fractures of the distal radius although severe chronic cases with serious and sometimes
devastating disability are fortunately less common, occurring in less than 2% of cases.
CRPS type 2 occurs in association with damage to a peripheral nerve and CRPS type 1
in the absence of nerve pathology. The cardinal features are abnormal or neuropathic
pain, temperature changes, abnormal sweating, swelling, joint stiffness and atrophy, and
bone changes. The mainstay of treatment is multidisciplinary, with effective analgesia
often with the advice of a pain specialist and intensive physical therapy. Surgery should
be avoided unless there is good evidence of peripheral nerve compression, mostly
commonly a carpal tunnel syndrome. Other treatment modalities include intravenous
guanethidine blockade, Vitamin C, and desensitisation
89. Paciente com Torcicolo congênito à direita, qual deve ser a medida de
alongamento do musculo acometido: rotação do pescoço para direita ou esquerda?
Inclinação para direita ou esquerda?
Tadchjian 4th p 216
R: Alongar com inclinação para esquerda e rotação para direita.

The most common form of congenital painless torticollis is congenital muscular
torticollis, or wry neck. The deformity is usually obvious at birth or shortly afterward.
The child's head is tilted toward the involved fibrotic sternocleidomastoid (SCM)

Página 26 de 34
muscle and the chin is rotated toward the contralateral shoulder, producing the “cock
robin” appearance (Fig. 11-5A). The diagnosis is made on physical examination by
detecting a mass or knot on the involved side of the neck in the body of the SCM
[99,117]
muscle in the first 3 months of life (Fig. 11-5B). The mass may regress after early
infancy and be replaced by a readily palpable fibrous contracted band that can be
followed from its origin on the mastoid to the sternum and clavicular insertions.
[25]
Although Coventry and Harris reported this mass was undetected in 80% of patients,
the contracture is almost universally present after infancy.
90. Luxação congênita da cabeça do rádio é mais frequente para: posterior e

posterolateral ou anterior e anterolateral?
R: posterior e posterolateral
Congenital dislocation of the radial head is rare, but should be suspected when the head
has been dislocated for a long time, there is no evidence that the ulna has been
fractured, and the radial head appears abnormally small and misshapen. The
radiographic findings are fairly characteristic. The radial shaft is abnormally long, and
the ulna usually is abnormally bowed. The radial head is dislocated, frequently
posteriorly, but sometimes anteriorly; is rounded, showing little if any depression for
articulation with the capitellum; and usually is smaller than normal. Occasionally, there
is an area of ossification in the tissues around the radial head. The capitellum also may
be small, and the radial notch of the ulna that should articulate with the radial head may
be small or absent. Although bilaterality has been listed in older studies as a criterion
for diagnosis of congenital dislocation of the radial head, more recent reports have
confirmed the existence of unilateral dislocations. Congenital dislocation of the radial
head may be familial, especially on the paternal side, and may be associated with
chondro-osteodystrophy.

Página 27 de 34
91. Offset lateral do úmero na artroplastia vai da região mais lateral do coracoide
até qual região: centro da cabeça, porção lateral da tuberosidade maior ou menor?
Campbell 11th p 486
R: porção lateral da tuberosidade maior

The superior margin of the humeral head articular surface normally is superior to the top
of the greater tuberosity by 8 to 10 mm; maintenance of this relationship is important in
functional outcome (see Fig. 8-2). Restoring the center of rotation for the humeral head
in relation to the axis of the humeral diaphysis may play a role in prolonging glenoid
fixation and decreasing polyethylene wear. The distance from the lateral base of the
coracoid process to the lateral margin of the greater tuberosity is called the lateral
humeral offset
92. Luxação periseminular: além de desvio ulnar, qual posição do membro no

momento do trauma? Flexão ou extensão, pronação ou supinação?
Pardini traumatismo da mão 4ed p 501
R: Pronação e extensão
Desvio ulnar com extensão e pronação (sequencia de Mayfield).
93. Radiografia mostrando calo atrófico em diáfise: qual tratamento da

pseudoartrose de fêmur após 7 meses de haste intramedular? Enxertia, troca da
haste com fresagem do canal, dinamização da haste?
RW 7th p 1711
R: troca da haste com nova fresagem.

Although dynamization may be effective in some cases, there is only retrospective
literature suggesting some success in patients who may have otherwise healed. In most
cases, removal of the plate and placement of a reamed intramedullary nail achieves
these goals and is the most reliable method of treatment. In a prospective and
randomized study of 40 patients with nonunions following plate fixation, treatment
consisted of interlocked reamed nailing with or without autogenous bone grafting.
Treatment with a reamed nail without bone grafting resulted in similar results with less
operating time and blood loss.
94. Qual tipo de Watanabe causa ressalto no joelho? I, II, III, ou IV?
Campbell 11th 2435
R: III
Discoid lateral menisci generally are categorized, according to the system of Watanabe
et al., as complete, incomplete, and Wrisberg type, on the basis of the degree of
coverage of the lateral tibial plateau and the presence or absence of the normal posterior
meniscotibial attachment. Complete and incomplete types are more common, are disc
shaped, and have a posterior meniscal attachment. These types usually are
asymptomatic, with no abnormal motion of the meniscus during knee flexion or
extension. If an incomplete or complete discoid meniscus is torn, symptoms are similar
to those of any other meniscal tear: lateral joint line tenderness, clicking, and effusion.
Wrisberg-type discoid menisci usually are nearly normal in size and shape and have no
posterior attachment except the ligament of Wrisberg. Because this type is not disc
shaped, Neuschwander et al. described it as a “lateral meniscal variant with absence of
the posterior coronary ligament” to distinguish it from a truly discoid meniscus.
Wrisberg-type discoid menisci often occur at a younger age than complete or

Página 28 de 34
incomplete types and are unassociated with trauma. Abnormal motion of this type of
discoid meniscus results in a popping sound during knee flexion and extension
(“snapping knee syndrome”).
95. ?
96. Quais principais localizações do cisto ósseo simples?

Campbell 11th p 866
R: Fêmur e úmero proximal.

Any bone of the extremities can be affected, but unicameral bone cysts are most
common in the proximal humerus and femur. In adults, the ilium and calcaneus are
more common locations.
97. Qual principal deformidade associada à fêmur curto congênito? Coxa vara,
PTC, hemimelia fibular ou pseudoartrose da tíbia?
R: hemimelia fibular
Patients with PFFD have a characteristic appearance. The affected thigh is extremely
short, the hip is flexed and abducted, the limb is externally rotated, there is often flexion
contracture of the knee, and the foot is usually at the level of the contralateral knee
(Figure 33-20). Flexion contractures of the hip and knee make the limb appear shorter
than it actually is anatomically. The actual discrepancy can be better determined by
comparing the length of the two limbs while the patient is sitting. Although the hip
abductors and extensors are present, they are foreshortened and unable to function
properly because of the abnormal anatomy of the proximal femur. The knee joint is
[8]
positioned in the groin and acts as an unstable intercalary segment. In approximately
45% of cases, the patient also has ipsilateral fibular hemimelia of the affected limb, with
a short tibia and an equinovalgus deformity of the foot. Lateral rays of the foot may be
missing. The disorder may be accurately diagnosed prenatally with sonography.
98. Qual ligamento está lesionado na fratura de Jefferson? Nucal, alar, transverso?
RW 7th p 1345
R: transverso
The classic Jefferson fracture pattern denotes bilateral fractures in the anterior and
posterior aspect of the ring. However, the mechanical significance of a single burst
fracture in the anterior and posterior ring is the same. As long as the left and right sides
of the ring have been dissociated, the potential for injury to the C1-C2 facet joint and
the transverse ligaments is present. The exact location of the fractures can vary
substantially, with some injuries occurring through the lateral masses. The distinction
between stable and unstable Jefferson or burst fractures is the integrity of the transverse
ligaments. The transverse ligament is disrupted in tension with lateral displacement of
the fragment fragments, which can lead to C1-C2 instability.
99. Qual estrutura provoca desvio na fratura do epicôndilo lateral na criança?

Extensor radial longo do carpo, extensor comum dos dedos ou braquiorradial?
R: Extensor radial longo do carpo

Página 29 de 34
In adults, the most common etiology is that of a direct blow to the lateral side of the
elbow. In children, because the forearm extensor muscles originate from this area, it is
believed that avulsion forces from these muscles can be responsible for some of these
injuries. Hasner and Husby (161) suggested that the fracture line's location in relation to
the origins of the various extensor muscles determines the degree of displacement that
can occur (Fig. 15-61). If the proximal part of the fracture line lies between the origin of
the common extensors and the extensor carpi radialis longus, there is usually little
displacement. If the fracture lines enter the area of origin of the extensor carpi radialis
longus, then considerable displacement can occur.
100. Indicações da Artroplastia reversa de ombro: seringomielia, pseudo paralisia,

Charcot?
Campbell 11th p509
R: pseudoparalisia
Current indications for reverse shoulder arthroplasty are rotator cuff arthropathy and
pseudoparalysis, multiple failed rotator cuff repairs with poor function and
anterosuperior instability, failed hemiarthroplasty and anterosuperior instability, and
significant loss of tuberosity bone or malunion of the tuberosity after fracture. Reverse
shoulder arthroplasty is appropriate for patients with an intact deltoid, adequate bone
stock to support the glenoid component, no evidence of infection, no severe neurologic
deficiency (Parkinson disease, Charcot joints, syringomyelia), and no excessive
demands on the shoulder joint. Patients also must be willing to modify their
postoperative physical activities. Contraindications include loss or inactivity of the
anterior deltoid and excessive glenoid bone loss that would not allow secure
implantation of the glenoid component. Some authors have suggested that the procedure
is unsuitable for patients younger than 70 years old. Rheumatoid arthritis is a relative
contraindication because of concerns about glenoid loosening.
Outras:
*Qual a principal localização da lesão dos isquiotibiais? Avulsão óssea no ísquio,
tendinosas, da junção miotendínea?
R: Avulsão óssea
Avulsion fractures occur most commonly in adolescent athletes; they occur in the
anterior superior and anterior inferior iliac spines and in the ischial tuberosity and are
caused by overpull of the sartorius muscle, rectus femoris muscle, and hamstring
muscles.
*Mielo e escoliose: qual fatores de progressão? Meningite, medula ancorada e

hidrocefalia?
Campbell 11th p1472
R: medula ancorada e hidrocefalia.

Paralytic spinal deformities have been reported in 90% of patients with
myelomeningocele. Scoliosis is the most common deformity and usually is progressive.
The incidence of scoliosis is related to the level of the bone defect and the level of
paralysis. Moe et al. noted a 100% incidence of scoliosis with T12 lesions, 80% with L2
lesions, 70% with L3 lesions, 60% with L4 lesions, 25% with L5 lesions, and 5% with
S1 lesions. The curves develop gradually until the child reaches age 10 years and may
increase rapidly with the adolescent growth spurt. Raycroft and Curtis differentiated
between developmental (no vertebral anomalies) and congenital (structural
abnormalities of the vertebral bodies) scoliosis in patients with myelomeningocele. The
two types were almost evenly divided in their patients. They suggested muscle
imbalance and habitual posturing as causes of developmental scoliosis. Developmental

Página 30 de 34
curves occur later than congenital curves, are more flexible, and usually are in the
lumbar area with compensatory curves above and below. Several authors have
suggested that developmental scoliosis can be caused in some patients by hydromyelia
or a tethered cord syndrome, and an early onset of scoliosis (before age 6 years)
frequently occurs in patients with these lesions.
*Imagem clínica e radiológica de adolescente com cifose de Sheurmann. Pedia

diagnóstico: postural ou dorso curvo do adolescente?
R: Dorso curvo do adolescente
*Ligamento de Lisfranc: origem e inserção?
R: do cuneiforme medial a base do segundo metatarso.

The important characteristics to note are (a) the plantar ligaments are significantly
stronger than the dorsal ligaments, (b) the multiple ligaments overlap among the joints
of the lesser four tarsometatarsal joints, and (c) the Lisfranc ligament, which is the
largest and strongest ligament of this joint complex, represents the only ligamentous
support between the medial leg and the middle and lateral legs in the forefoot. The
Lisfranc ligament originates from the plantar lateral aspect of middle and lateral legs in
the forefoot. The Lisfranc ligament originates from the plantar lateral aspect of the
medial cuneiform just below the plantar extent of the second tarsometatarsal joint and
inserts on the plantar and medial aspect of the second metatarsal base. At best it is an
indirect link between the first and second metatarsals. There is no interligamentous
connection between the first and second metatarsal.
*O que o ângulo de Southwick mensura? A gravidade do deslocamento, a

porcentagem do deslocamento?
R: gravidade do deslocamento
FIGURE 18-2 Southwick method of measuring the head–shaft angle to assess the
severity of slipped capital femoral epiphysis. A, Lines are drawn corresponding to the
axis of the femoral shaft and the base of the capital femoral epiphysis. The head–shaft
angle is the angle between the axis of the femoral shaft and the perpendicular to the
base of the epiphysis. Normally this angle is 145 degrees. B, Similar lines may be
drawn on the frog-leg lateral radiographs. Mild slips have less than 30 degrees of
displacement, moderate slips have 30 to 60 degrees of displacement, and severe slips
have more than 60 degrees of displacement compared with the contralateral normal
side.

Página 31 de 34
PROVA PRÁTICA
PARTE 1
Fratura supracondiliana em criança

Fratura de odontoide
Fratura de tíbia
Fratura-luxação de acetábulo
Fratura da cabeça do rádio em adulto
Fratura do fêmur distal em criança
Fratura do rádio distal em adulto
Fratura avulsão da tuberosidade da tíbia na criança
Anatomia e biomecânica do pé
Coalisão tarsal
Instabilidade do ombro
Pé torto congênito
Perthes
Gonartrose e ATJ
Lesão patelar no adulto
Espondilolistese ístmica
Osteoporose
Osteomielite de fêmur pós operatória
Transporte de tíbia
Osteoblastoma
Exame Físico normal do ombro, escoliose, quadril na criança (4 meses), LCP, pourrier
(thompson Aquiles, Kelikian-ducroquet, Maudsley, pivot-shift do cotovelo).
Habilidades: Acesso em zigue zague e sutura de Kessler, Cobb, Pavlik, ATQ, fixador
externo em cotovelo flutuante, síndrome compartimental do antebraço.
PARTE 2
Fratura supracondiliana em criança

Fratura transtrocanteriana
Fratura cervical baixa (listese C5-C6)
Fratura de tornozelo (SRE)
Fratura intertrocantérica na criança
Fratura diafisária de úmero
Fratura-luxação transescafosemilunar
Pseudoartrose de fêmur pós-operatória
Síndrome compartimental da perna
Anatomia e biomecânica da coluna
Anatomia do plexo de braquial
Pubalgia
Osteonecrose do joelho
Pé diabético
Blount
Paralisia cerebral em hemiplégico (avaliar contraturas)
Artrose Glenoumeral
Osteossarcoma de fêmur distal
Lesão de Aquiles
Exame Físico: ?
Habilidades: ?
PARTE 3

Página 32 de 34
Fratura diafisária de fêmur
Fratura de úmero proximal
Fratura de úmero distal
Fratura de colo femoral
Fratura coluna toracolombar por osteoporose
Fratura de tornozelo na criança
Fratura de Lisfranc
Fratura do escafoide
Fratura diafisária do antebraço na criança
Fratura exposta
Hálux valgo
LCA
Anatomia e biomecânica do joelho
Raquitismo
Epifisiólise
Cisto ósseo simples
Metástase
Sd compressiva do ulnar
Exame físico: Normal do quadril, DDQ, instabilidade do ombro, túnel do carpo,

Pourrier (Mausdley, Neer, Thomas, McMurray, Coleman).
Habilidades: ATN, planejamento, lesão de tendão flexor (Keesler modificado com zeta),
Sd compartimental do antebraço.
PARTE 4
Fratura de clavícula
Fratura de galeazzi do adulto
Fratura de radio distal da criança
Fratura supracondiliana de cotovelo no adulto
Fratura supracondiliana de fêmur no adulto
Fratura diafisária do fêmur criança
Fratura do calcâneo
Fratura do anel pélvico
Fratura da Coluna lombar
Luxação da Acrômio-clavicular
Tipos de síntese e estabilidade
Osteonecrose da cabeça femoral
Artrite séptica
Lesão meniscal
Halux valgo no pé reumatoide
Mielomeningocele
Insuficiência do tibial posterior
Ewing
Anatomia e biomecânica do punho
Paget
Exame físico: Exame físico: Normal do quadril, DDQ, instabilidade do ombro, túnel do
carpo, Pourrier (Mausdley, Neer, Thomas, McMurray, Coleman).
Habilidades: eixo dos membros inferiores, fixador externo da tíbia, Pavlik, fasciotomia

Página 33 de 34
PARTE 5
Luxação da primeira metacarpo-falangiana

Luxação da articulação glenoumeral
Fratura do Tálus (corpo)
Fratura do fêmur distal no adulto
Fratura do capitelo na criança
Fratura-luxação de Monteggia
Fratura-luxação de Lisfranc
Fratura de platô tibial
Maus tratos (fratura do colo femoral na criança)
Anatomia túnel do carpo e tendões extensores do punho
Lesão ligamentar do tornozelo
Coxartrose
Mieloma múltiplo
Osteonecrose idiopática do joelho
Estenose lombar
Osteomielite de joelho em criança
Tendinite calcárea
Lesão do nervo ulnar (egawa, froment)
Pé cavo
Sindactilia
Exame físico: normal da coluna vertebral, DDQ aos 4 meses (pistonamento, Hart, peter-
blade, Ortolani e Barlow), entorse de tornozelo, lesão de menisco, avaliar C5, Pourrier
(Maudsley, avaliar C7, Jack test, Ober, Kernig).
Habilidades: Ângulos normais do punho, Pavlik, lesão de tendão extensor (ponto U e

zetaplastia), Síndrome compartimental do antebraço, Corte tibial da ATJ, fixador de
pelve, template de ATQ, artroscopia de joelho, componente acetabular, Linhas na
fratura do acetábulo, parafuso de tração.

Página 34 de 34

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Pedro Braga Linhares Garcia

1. Localização mais comum do granuloma eosinofílico na coluna?

R: desvio dorsal da primeira fileira

FIGURA 20.9: radiografias em PA com desvio ulnar mostrando o alongamento do

3. Ficat – Arlet osteonecrose de Joelho: qual grau há fratura subcondral e colapso

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6. Teste de pivot-shift para cotovelo: qual instabilidade é testada?

8. Fixador externo: pino de titânio é mais ou menos flexível? Infecta mais ou

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R: titânio é menos rigidez (mais flexível) e tem menor taxa de infecção

O módulo de Young ou módulo de elasticidade é um parâmetro mecânico que

9. Qual sintoma mais comum do mieloma múltiplo?

10. Articulação mais acometida no pé na artropatia de Charcot?

Eichenholz provided a classification and staging system that is useful in Charcot

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BRODSKY (classified by the anatomical location): Type 1 involves the

13. Delbet-Colonna: classificar imagem de fratura de quadril na criança. Tipo II

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16. Sinal do gancho para desinserção distal do bíceps braquial? Ativa/passiva?

17. Músculos inervados por C8?

R: flexores dos dedos

* Indicative of C7-T1 disc rupture or other pathological condition at that level.

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R: elevação do arco longitudinal do primeiro raio e supinação do antepé.

20. Displasia radial pela classificação de Heikel: a partir de qual grau há

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22. Qual significado do ball-sign para fratura do tornozelo no adulto? Lesão da

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R: Abdução e rotação interna.

R: Fêmur distal ou tíbia proximal?

R: Proximal e acesso único

26. C7: qual déficit neurológico?

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27. Órtese para lesão do nervo ulnar? Flexão ou extensão da interfalangiana ou da

28. Qual deformidades podem ocasionar in-toening: aumento da retroversão ou

R: Aumento da anteversão femoral e da torção interna da perna?

29. O que são os nódulos de Garrod na doença de Dupuytren?

R: tumoração no dorso da interfalangiana proximal

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31. O que é fratura de Segond?

R: Fratura da margem lateral da tíbia

33. Ressalto no quadril é mais comum em mulheres ou homens, jovens ou idosos?

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34. Imagem de manobra de redução de quadril: Allis, Stimson?

35. Artropatia do manguito rotator: qual a característica radiográfica? Esclerose

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38. Quais parâmetros usados no ISIS para ombro? Idade da cirurgia ou da

R: idade da cirurgia e atividade esportiva

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41. Qual localização da dor na perna no pós-operatório de haste de tíbia? No local

43. Raquitismo nutricional: FA e Cálcio elevados ou normais?

R: Cálcio normal e FA elevada

Table 32-1 -- Biochemical Abnormalities in Rickets

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44. Qual desvio do fragmento lateral da fratura da diáfise da clavícula? Superior

R: translação anterior e inferior

45. Definição de choque medular: lesão temporária ou definitiva? Há abolição ou

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47. Imagem radiológica em AP e perfil de pé na criança: PTC, metatarso aduto, pé

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49. Fratura de úmero proximal no idoso? Mulher ou homem? Lado dominante ou

R: mulher, lado não dominante