Achondroplasia

 FGFR 23
 decreased number of chondrocytes in the proliferative zone of the physis

Aggrecan
 Binds to H2O
 Increased in early osteoarthritis, decreased in late osteoarthritis

Alkaline phosphatase
 Bone and liver

Amputation energy expenditure

 Transtibial: 25% more
 Transfemoral: 65% more

ANOVA
 comparing more than two groups or variables

Anterior hip
 Can have femoral nerve palsy due to placement of an acetabular retractor
outside of the safe zone during acetabular preparation

Anterior ilioinguinal approach

 Corona mortis at risk (anastomosis between the obturator and the external
iliac or inferior epigastric arteries or veins)

Articular cartilage
 Type II collagen
 Deep zone: perpendicular collagen fibrils and the highest proteoglycan
content

Atypical femur fx
 a/w bisphosphonate use
 Duration of treatment for the disease has the highest association with the
development of atypical femur fx

Autosomal dominant hypophosphatemic rickets

 XLD
 FGF23

Bacterial biofilm
 Persister cells within the bacterial biofilm are resistant to increased
concentrations of antimicrobial agents and can repopulate the biofilm, which
results in relapse of infection

Bending rigidity
 Increase diameter of nail improves bending rigidity third power of the radius
Blood flow restriction
 Promote hypertrophy and strength

Calcitonin
 inhibits sclerostin formation and inhibits osteoclast apoptosis

Cathepsin K
 Protease involved in the degradation of the organic matrix when bone
remodeling occurs

Center edge angle

 Normal 25-40 degrees

Ceramic
 High compressive strength
 High wettability
 Brittle

Chi-square
 Categorical variables

Chondrocyte degrade via apoptosis

Cleidocranial dysplasia
 absent or hypoplastic clavicles
 Runx2/CBFA1
 Affects osteoblasts

Clinical significance
 Patient-reported outcome measures (PROMs): Minimum clinically important
difference (MCID)

Cohort study
 Measures incidence (new cases of a disease over a period of time)
 Can determine causality

Common peroneal nerve decompression sites

 where it passes underneath the fascia of the peroneus longus and at the
intermuscular septum between the lateral and anterior compartments (b/n
peroneus longus and EDL)

Confidence interval
 Mean +/- 1.96 SD

Cross-sectional survey
 Prevalence (number of individuals with the condition divided by the total
number of individuals at one point in time)

Dabigatran
 direct inhibitor of activated factor II (thrombin)
Decorin
 important factor in collagen fiber size during tendon formation and repair
after injury

Denosumab
 Binds to RANKL
 Can be used to treat giant cell tumor of bone

Degenerative disc disease

 Decreased Aggrecan
 Increased Metalloproteinases

Demineralized bone graft

 Osteoconductive, osteoinductive

Distraction osteogenesis
 Initiate distraction 7 days after surgery; distract at 1 mm per day

Duchenne muscular dystrophy

 XLR, DMD gene, Xp21

Ductility
 the ability of a material to undergo plastic deformation rather than breaking
 metals generally have better ductility than ceramics

DVT prophylaxis
 isolated lower extremity fracture below the knee AAOS guideline is no
chemical prophylaxis
 Factor V Leiden: no change in dosage or length of anticoagulation

Elastic modulus
 Stiffness
 A material with a higher elastic modulus will deform less to a given load than
will a material of a lower elastic modulus

Enthesis
 Contains free nerve endings responsible for nociception

Epigenetics
 influence of an organism’s environment on gene expression that occurs
without changes in the actual genome

Epiphysiodesis surgery
 most important location to ablate basement plate

Etanercept
 competing for tumor necrosis factor (TNF)-alpha binding sites on target cells
External fixation stability
 placement of pins from multiple directions
 increasing the diameter of the pins
 mounting the bar as close as possible to the bone
 maximizing the distance between pins on each side of the fracture

FAITH trial
 1079 patients with low-energy femoral neck fractures requiring fixation and
assessed them clinically up to 24 months postoperatively
 Factors that were statistically significant and associated with revision surgery
include female gender, higher body mass index, displaced fracture,
unacceptable quality of implant placement, and patients who smoke
cigarettes treated with cancellous screws versus being treated with a sliding
hip screw

Fatigue strength
 measure of the stress that a material can withstand under cyclic loading

Femur ex-fix
 4 cm distal to the level of the isthmus

Flexor tendon healing

 During the initial inflammatory stage, formation of a fibrin clot and vascular
invasion to the site of injury occur within the first week.
 Proliferative stage: 7 to 21 days after injury; fibroblast synthesize into
immature type III collagen in an unorganized manner; leads to scar formation
within the tendon
 Remodeling stage: 1 to 2 months; type I collagen fibers are reoriented in a
longitudinal manner, and collagen fibrils begin cross-linking to one another.

Fondaparinux
 Indirect inhibition of the clotting cascade at the level of factor X

Fragility index
 measure of how many alternate outcomes must occur in the results of a
research trial to change the statistical outcome of the trial.

Fretting corrosion
 Micromotion between two pieces of metal that are not loose

Galvanic corrosion
 dissimilar metals produce an electrochemical circuit

Gait
 Osteoarthritis of knee can lead to increased adductor moment

Harvesting mesenchymal stem cells from iliac crest: posterior aspiration with
multiple smaller volumes.
Hip joint load
 Normal walking: 2 to 3.5 times body weight
 Fast walking: 7 to 8 times body weight

Hueter-Volkmann law
 Tension increases growth whereas compression inhibits growth

Integrin
 responsible for osteoclast attachment to bone

Interobserver reliability
 Use Cohen's kappa coefficient

Knee kinematics
 Tibia subjected to IR with knee flexion and ER with knee extension

Lateral approach to spine

 During lateral access surgery of the L4-5 disk, the femoral nerve lies directly
over the L4-5 disk from the lateral approach and is at risk
 The genitofemoral nerve forms lateral from the spine itself from the L1 and L2
nerve roots
 The lateral femoral cutaneous from the L2 and L3 nerve roots

Lateral femoral cutaneous nerve (LFCN)

 medial to the ASIS and deep to the inguinal ligament

Level of evidence
 1: meta-analysis, high quality randomized controlled study with greater than
80% follow up

Li-Fraumeni syndrome
 p53

Malnutrition
 Total lymphocyte count, serum prealbumin, serum albumin, and serum
transferrin

Mann-Whitney test
 compare differences between two groups when dependent variables are
ordinal or continuous.
 Non-normal distribution
 Example: male and female difference between those who tore ACL and those
who did not

Marfan
 Fibrillin gene (FBN1)
 Mutation on fibrillin gene prevents TGF-β binding, resulting in elevated TGF-β
levels

Matrix metalloproteinases (MMPs)

  enzyme vital to cancer cell invasion of the basement membrane

Mechanical axis
 Line drawn from the center of the femoral head to the center of the tibial
plafond
 Deformities closer to the knee have a greater impact on the mechanical axis
deviation at the knee than deformities of the same magnitude more proximal
in the femur or distal in the tibia away from the knee

Metal on metal
 Lymphocyte driven

Microfracture
 results in the formation of fibrocartilage

Morel-Lavallee lesion
 caused by a shearing force that separates the fat from the underlying fascia

Morphine milligram equivalents (MME) for hydrocodone, oxycodone, and

hydromorphone
 1, 1.5, 4

Most common reason publications in the orthopaedic literature are retracted

 Plagiarism

MRSA
 PVL virulence factor

Neisseria gonorrhoeae (N gonorrhoeae)

 Lower influx of WBC into the joint

Nerve conduits
 Type I collagen

Nerve regeneration
 Schwann cells
 Endoneurium must be intact

Nonunion
 Infection
 Atrophic: needs biology
 Hypertrophic: needs stability (benefit from supplemental fixation to improve
the mechanical stability for healing)

Northern blot
 RNA

NSAIDs and fracture healing

  The effect on healing in animal studies occurs through a decrease in
endochondral ossification, because NSAIDs decrease chondrogenic
differentiation

Osteogenesis imperfecta
 AD
 missense mutation results in a substitution of glycine by another amino acid

Ossification of carpal bones

 Capitate, Hamate, Triquetrum, Lunate, Scaphoid, Trapzium, Trapezoid,
Pisiform

Osteoclast
 Monocytic lymphocyte origin

Osteogenic bone graft

 provides cells that are capable of bone formation
 Autograft

Osteolysis
 IL-1, IL-6, TNF-alpha, NFKB-ligand

Osteoprotegerin
 decoy receptor for RANKL

Paget disease
 Alkaline phosphatase is the most sensitive laboratory marker for this disease
 inactivating mutation in OPG.

Parathyroid hormone
 chondroregenerative and chondroprotective properties

Pediatric proximal femur

 More anterversion and higher neck-shaft angle than adults

Pediatric septic arthritis

 Staph aureus most common; other causes is GBS and Kingella
 Kingella usually presents with milder symptoms/lab values/aspiration results

Pitting corrosion
 Formation of small pits in the metal
 Stainless steel

Positive predictive value

 TP / (TP+FP)

Power analysis
  help the researcher determine the smallest sample size that is suitable to
detect the effect of a given test or intervention at the desired level of
significance, which is usually set at 80%
 Power: 1- Type 2 error
 Type 2 error: reports a negative result when in fact a true difference exists
(false negative)
 If you increase power in a study, you increase confidence if a negative result
is found

Primary bone healing

 intramembranous ossification
 low interfragmentary strain, more stable vascularity, and higher oxygen
tension
 periosteal derived bone precursor cells
 fixation constructs with absolute stability

Prospective cohort
 Eliminates bias

PTH
 only anabolic agent currently available for the treatment of osteoporosis

P value
 indicates the probability of a type I error when an association is found in the
study when in fact no true association exists
 reflects the confidence one has in a positive study result
 P value cutoff of 0.05, this indicates that there is a 5% chance that a positive
result is not valid.

Relative risk
 (A/A+B) / (C/C+D)

Retrospective cohort
 Use for rare conditions due to low number of patients

Reverse dynamization
 Allowing micromotion to promote callus formation during early healing,
followed by changing to more rigid fixation to accelerate the progression
toward union

Revision arthroplasty
 negative pressure dressings were found to be associated with significant
decrease in surgical site infections after revision total knee replacement and
revision total hip replacement.

SCFE
 Obesity, increased leptin, increased hypertension

Schuermann kyphosis
 Histopathology: ectopic calcifications
Sclerostin
 inhibits osteoblast activity in routine bone remodeling

Scoliosis rods
 manually contoured cobalt-chromium rods generated significantly greater
correctional forces while demonstrating less plastic deformation

Secondary bone healing

 higher interfragmentary strain, lower oxygen tension resulting in hypoxia at
the fracture site, and healing mediated by a cartilage precursor
 This healing is also called endochondral ossification

Sensitivity
 TP/(TP+FN)

Shelf life
 Freeze dried bone: 5 years

Skeletal age more accurate to predict child growth during adolescent period

Southern blot
 DNA

Specificity
 TN/(TN+FP)

Spine disc
 Annulus fibrosis (type I collagen)
 Nucleus pulposus (type II collagen)

Spinopelvic anatomy
 If sitting and standing pelvic radiographs showing a change in sacral slope of
<10°, this is consistent with a stiff spinopelvic junction, resulting in
compensatory increased hip motion.

Strain
 Change in length / original length

Strict inclusion criteria decreases external validity

Tibial plateau fx
 3 to 6 times higher risk of needed TKA due to posttraumatic arthritis

Traumatic spinal cord injury

 Cervical spinal stenosis with <10 mm of space available for the spinal cord
has been shown to be directly relevant to neurologic loss

Triage
  Immediate – severely injured patients who require urgent life-saving
treatment given available resources
 Delayed – those injured who are not in immediate need of life-saving
interventions
 Minimal – minor injuries with no imminent need for treatment
 Expectant – the most severely injured with no spontaneous breathing or
those unlikely to survive based on the severity of injuries, available resources
or both

Trunnionosis
 a/w multiple factors: larger head size, long neck, high offset, taper geometry
(low angled taper), taper rigidity (increased risk for trunnionosis with more
flexible taper designs)

T-test
 Normally distributed variables

Tuberculosis infection
 Tx: rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE)

Type 1 error (false positive)

 null hypothesis is rejected, but the null hypothesis is true
 conclusion of the study incorrectly indicates a difference between the study
groups when a difference does not exist (false positive)

Type 2 error (False negative)

 null hypothesis is accepted, but it is false
 concludes there is no difference between study groups when a difference
really does exist

Vancomycin
 Inhibits cell wall synthesis

Vitamin D deficiency
 25-Hydroxyvitamin D <20 ng/mL

Yield strength
 measure of the stress that the material can withstand up to the point of
plastic deformation of the material