Arab Board Orthopedic Surgery Clinical cheat sheet

Open fracture: urgent IV antibiotics, tetanus prophylaxis, and surgical debridement; Gustilo-Anderson grade guides prognosis and fixation strategy.

Compartment syndrome: pressure >30 mmHg or within 30 mmHg of diastolic pressure is an indication for emergent fasciotomy.

Neck of femur fractures: intracapsular fractures in elderly are treated with arthroplasty; extracapsular fractures with intramedullary nailing.

Tibial shaft fractures: reamed intramedullary nailing is standard for diaphyseal fractures; compartment monitoring is mandatory.

Pediatric supracondylar humerus: Gartland classification; type III requires closed reduction and percutaneous pinning.

Damage control orthopedics: temporary external fixation for polytrauma patients to minimize second hit.

Fracture healing: inflammatory, reparative, and remodeling phases; nonunion defined as no healing at 6-9 months.

Ankle fractures: stability depends on medial clear space and syndesmosis; stress views guide operative indication.

Total hip arthroplasty: cup inclination 40-45 degrees, anteversion 15-20 degrees; combined anteversion 25-50 degrees.

Periprosthetic joint infection: major criteria include sinus tract communicating with joint or two positive cultures with same organism.

Aseptic loosening: progressive radiolucent lines >2 mm, component migration, or cement mantle fracture.

Total knee arthroplasty: mechanical axis neutral; femoral component 5-7 degrees valgus, tibial slope 3-5 degrees.

Hip resurfacing: indicated in young active males with good bone stock; contraindicated in females of childbearing age and renal impairment.

Revision THA: Paprosky classification for acetabular defects; femoral defects classified by Paprosky or Vancouver.

Venous thromboembolism prophylaxis: aspirin, LMWH, or factor Xa inhibitors for 10-35 days after arthroplasty.

Cauda equina syndrome: emergent MRI and decompression within 24-48 hours; red flags include saddle anesthesia and bowel/bladder dysfunction.

Cervical myelopathy: Nurick grade, JOA score; anterior vs posterior approach depends on levels and lordosis.

Thoracolumbar fractures: TLICS score ≥5 operative; <4 nonoperative; 4 either.

Scoliosis: Cobb angle >45-50 degrees in skeletally immature indicates progression; Risser sign and triradiate cartilage guide bracing.

Lumbar stenosis: neurogenic claudication, relieved by flexion; surgical decompression for refractory symptoms.

Spondylolisthesis: Meyerding grading; grade I-II degenerative treated conservatively; grade III+ or progressive considered for fusion.

Spine infection: discitis/osteomyelitis; MRI with contrast, biopsy for culture, 6-12 weeks antibiotics; surgery for instability or abscess.

ACL reconstruction: graft options include hamstring, patellar tendon, quadriceps; timing after injury to regain ROM and reduce arthrofibrosis.

Meniscal tears: stable peripheral tears in vascular zone (red-red) may be repaired; unstable or degenerative tears treated with partial meniscectomy.

Shoulder instability: Bankart lesion (labrum) and Hill-Sachs (humeral head); Latarjet for significant glenoid bone loss (>20-25%).

Rotator cuff: acute full-thickness tears in young patients should be repaired; massive chronic tears may need tendon transfer or reverse arthroplasty.

Cartilage lesions: microfracture for small (<2 cm²) lesions; osteochondral autograft or allograft for larger defects.

Hip arthroscopy: femoroacetabular impingement (cam/pincer) treated with osteochondroplasty and labral repair.

Developmental dysplasia of hip: Ortolani and Barlow maneuvers in neonates; Pavlik harness for <6 months; closed reduction and spica for older.

Legg-Calvé-Perthes: lateral pillar classification; age <6 and lateral pillar A/B have better prognosis.

Slipped capital femoral epiphysis: stable vs unstable; in situ pinning for stable; urgent reduction and pinning for unstable.

Clubfoot: Ponseti method (serial casting, Achilles tenotomy, bracing) is first-line.

Limb length discrepancy: predicted discrepancy <2 cm observation; 2-5 cm epiphysiodesis; >5 cm lengthening or shortening.

Pediatric bone cysts: unicameral bone cyst often in proximal humerus; simple curettage and bone grafting if symptomatic or at risk of fracture.

Carpal tunnel syndrome: nocturnal paresthesia, thenar atrophy; EMG/NCS; release of transverse carpal ligament.

Scaphoid fractures: most at waist; risk of nonunion and AVN; immobilize and follow up; surgery for displaced or proximal pole.

Dupuytren contracture: palmar fibromatosis; treatment for contracture >30 degrees at MCP or any PIP; options include fasciectomy, needle aponeurotomy, collagenase.

Distal radius fractures: volar locking plate for unstable; check DRUJ and ulnar styloid; early mobilization.

Trigger finger: A1 pulley release; steroid injection first-line for mild.

Nerve injuries: Seddon classification (neuropraxia, axonotmesis, neurotmesis); repair within 3 weeks for sharp lacerations.

Ankle sprain: lateral ligament complex; functional rehab; chronic instability treated with Broström repair.

Achilles tendon rupture: acute repair for active patients; nonoperative for sedentary; functional bracing.

Hallux valgus: intermetatarsal angle >15 degrees and hallux valgus angle >30 degrees often require surgery; first metatarsal osteotomy.

Plantar fasciitis: conservative management first; steroid injection, orthotics, stretching; surgery for refractory.

Ankle arthritis: tibiotalar arthrodesis vs total ankle arthroplasty; arthroplasty for low-demand older patients.

Diabetic foot: Charcot arthropathy; offloading and deformity correction; infection control.

Bone tumors: age and location guide differential; metaphysis and epiphysis patterns.

Osteosarcoma: most common primary malignant bone tumor in children; metaphysis of long bones; neoadjuvant chemo + surgery.

Ewing sarcoma: diaphysis; t(11;22) translocation; chemo + surgery/radiation.

Giant cell tumor: epiphysis of long bones; soap-bubble appearance; intralesional curettage and adjuvants.

Metastatic bone disease: breast, prostate, lung, kidney, thyroid; assess for impending fracture (Mirels score).

Soft tissue sarcoma: MRI for staging; biopsy tract planned with definitive surgery; wide resection.

Osteomyelitis: hematogenous vs contiguous; Staphylococcus aureus most common; MRI for early detection; antibiotics 4-6 weeks.

Septic arthritis: urgent aspiration and empiric IV antibiotics; surgical drainage; in children, Kocher criteria aid diagnosis.

Periprosthetic joint infection: diagnosis with MSIS/ICM criteria; treatment options include DAIR, one-stage, two-stage revision.

Osteoporosis: DEXA T-score ≤ -2.5; FRAX for fracture risk; bisphosphonates, denosumab, teriparatide.

Paget disease: elevated ALP, bone pain, deformities; bisphosphonates.

Rickets/osteomalacia: vitamin D deficiency; bowing, growth plate widening; replacement therapy.

Bone healing: primary (direct) vs secondary (callus); stability and gap determine healing mode.

Biomechanics: stress = force/area; strain = change in length/original length; Young's modulus = stress/strain.

Suture materials: absorbable (vicryl, monocryl) vs nonabsorbable (nylon, prolene); tensile strength and knot security.

Implant materials: titanium (osseointegration, MRI compatible), cobalt-chrome (wear resistance), polyethylene (wear debris).

Bone graft: autograft (gold standard), allograft, synthetic; osteoconduction, osteoinduction, osteogenesis.

Antibiotic prophylaxis: within 1 hour before incision; cefazolin for most; vancomycin for MRSA.

Sterile technique: surgical scrub, sterile drapes, traffic control; WHO surgical safety checklist.

Informed consent: discuss risks, benefits, alternatives, and consequences of refusal; document.

Confidentiality: protect patient information; exceptions for public safety and legal requirements.

Conflict of interest: disclose financial relationships with industry; avoid bias in decision-making.

Medical errors: disclose to patient and family; root cause analysis; culture of safety.

Capacity: assess understanding, appreciation, reasoning, and expression of choice; surrogate decision-makers.

Research ethics: IRB approval, informed consent, vulnerable populations protection.

Patient safety: hand hygiene, surgical time-out, medication reconciliation, fall prevention.