Universidade Federal do Amazonas

Hospital Universitrio Getlio Vargas

Servio de Ortopedia e Traumatologia

TARO 2015 GABARITO BASEADO NAS REFERNCIAS

Pesquisado por:
Jos Henrique, Rafael Chang, Sandokan Costa, rico Melo, Heyder Cabral,
Talita Oliveira, Gustavo Oliveira, Eduardo Ditzel, Luis Fernando Tupinamb,
Marcelo Gomes, Jaime Menezes e Luiz Felipe Tupinamb

1) A fratura da cavidade glenide que envolve seu tero superior e inclui o

processo coracide classificada segundo IDEBERG como tipo:
C) III

Fonte: Rockwood and Greens fractures in Adults 7th ed. 1155 pg.
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2)

Leucomalcia

periventricular

leso

caracterstica

A) Diplegia

Fonte: Lovell and Winters Pediatric Orthopaedics 6th ed. 554 pg.

da:

_________________________________________________________________
3)

artropatia

neuroptica

do

ombro

est

relacionada

a:

C) Siringomielia cervical

Fonte: Canale & Beaty: Campbells Operative Orthopaedics 11th 1045 pg.
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4) A sndrome medular central ocorre em idosos por mecanismo de:
B) Hiperextenso, e cursa com tetraparesia que afeta mais os membros
superiores

Canale & Beaty: Campbells Operative Orthopaedics 12th 1572 pg.

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5) Nas leses irreparveis do manguito rotador envolvendo os tendes
supraespinhal e infraespinhal, a transferncia muscular quando indicada
feita
com
o:
B) Grande Dorsal

Canale & Beaty: Campbells Operative Orthopaedics 11th 2619 pg.

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6) Na luxao glenoumeral anterior, a leso do ligamento glenoumeral
inferior
ocorre
na(s):
C) insero gleinodal

Canale & Beaty: Campbells Operative Orthopaedics 12th 2274 pg.

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7) A dor lombar aguda, aps excluso de sinais de alarme, deve ser tratada
com:
D) Respouso no leito por 1 a 3 dias e progresso para programa de
exerccios fsicos

Canale & Beaty: Campbells Operative Orthopaedics 12th 1901 pg.

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8) Na mo torta radial, a estabilizao do punho utilizando os flexores
superficiais deve incluir preferencialmente os tendes dos dedos:
A) Mdio e anular

Canale & Beaty: Campbells Operative Orthopaedics 12th 3722 pg.

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9- O cisto sseo simples geralmente detectado quando o paciente
apresenta.
B) Fratura patolgica
Unicameral Bone Cysts
UBCs are not always unicameral. They are also called simple bone cysts, but they
may not be simple to treat. These common lesions are usually found when the
patient sustains a pathologic fracture. Their radiographic appearance is so typical
that most can be diagnosed without a biopsy (Fig. 14.26). The proximal humerus
and the proximal femur are the sites that account for 90% of UBCs (383, 384,
385, 386, 387).
Fonte: Lovell and Winters Pediatric Orthopaedics 6 th ed. Pgina 526

10-A metastase ssea distal ao joelho ou ao cotovelo geralmente decorrente

de carcinoma
C) pulmo
The radiographic appearance of metastatic carcinoma varies. The appearance
usually is aggressive, suggesting malignancy. The lesions may be lytic, blastic,
or mixed. Breast cancer and prostate cancer typically produce blastic lesions.
Kidney cancer and thyroid cancer usually are purely lytic. Lung cancer may
produce a mixed appearance. If the lesion is distal to the elbow or knee, lung
cancer is the most likely primary lesion. Additionally, metastatic lung cancer
may have the distinct appearance of a bite taken out of the cortex.
Fonte:Canale & Beaty: Campbells Operative Orthopaedics 11th ed. Pagina 923
11- O fibroma ossificante localiza-se mais comumente.
A) na tbia
Osteofibrous Dysplasia
Kempson (349) described the osteofibrous dysplasia lesion, which is found in the
mandible and the anterior cortex of the tibia in children. It is benign, but may be
locally aggressive. It is not a healing NOF. The patients usually do not have
symptoms, and are brought to the physician's attention by a parent who has
noticed an anterior bowing or mass in the tibia. The lesion is almost always
located within the anterior cortex of the tibia, and is best seen on the lateral
radiograph (Fig. 14.22). There are often numerous radiolucent lesions with a rim

of reactive bone. On the technetium-99 bone scan, there is increased uptake in

the area of the lesion.
Fonte: Lovell and Winters Pediatric Orthopaedics 6 th ed. Pgina 521
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12- Durante a puberdade o crescimento do tronco
C) mais acentuado que o crescimento dos membros inferiores.
Puberty
During puberty (from 11 to 15 years in girls and from 13 to 17 years in boys)
there is a dramatic increase in the growth rate. However, during this period, the
growth is far more noticeable in the trunk than in the lower limbs: two thirds of
the growth goes toward increasing sitting height and only one third is toward
increasing subischial leg length.
Fonte: Lovell and Winters Pediatric Orthopaedics 6 th ed. Pgina 45
13-A fratura osteocondral do tlus na criana mais comum na regio
A) Medial
FRACTURES OF THE OSTEOCHONDRAL SURFACE OF THE TALUS
Damage to the osteochondral surface of the talus can be caused by direct trauma
or may be due to an underlying osteochondal lesion (osteochondritis dissecans
[OCD]) that may have been present for some time and has been made
symptomatic by the injury. The pathogenesis and etiology of OCD is
controversial; however, most authors report preceding trauma as a cause of the
defects (Canale and Bedding25 80%, Letts et al.91 79%, Higuera et al.65 63%, and
Perumal et al.123 47%). The medial
P.1026
lesion is usually deeper and cup shaped compared to the thinner wafer
type lateral lesion. The lateral lesion is more often associated with trauma and
more symptomatic than the medial lesions. It is postulated that the medial lesions
may be due to more repetitive microtrauma.25,26 Berndt and Harty,12 in 1959,
used freshly amputated legs to biomechanically reproduce injuries to the ankle
and observe the injuries inflicted. They showed that the anterolateral talus hits
the medial aspect of the fibula with dorsiflexion and inversion and that
plantarflexion and inversion caused posteromedial osteochondral lesions (Fig.
27-10).
Fonte: Rockwood and Wilkins Fractures in Children, 7th ed. Pagina 1026
14-A fratura de estresse no p da criana gerlmente ocorre
A) no colo do segundo metatarsal

STRESS FRACTURES
The second metatarsal is the most common bone in the foot to get a stress
fracture. This usually occurs at the neck of the metatarsal at the junction of the
mobile shaft and rigid metaphysis. Treatment involves rest and partial weight
bearing in a moonboot for 4-6 weeks.
Fonte: Rockwood and Wilkins Fractures in Children, 7th ed. Pagina 1054

15- A artralgia associada picada do carrapato geralmente observada no

b) joelho
Lyme Disease
Musculoskeletal symptoms include lower extremity cramping and a
predisposition for a proximal lower extremity myositis. There may be a
monarticular or migratory inflammatory arthritic presentation. Although the
knee is most commonly involved, arthralgia in other joints (e.g., shoulder and
wrist) frequently occurs and can recur later or become chronic. A chronic
synovitis has been described with pannus formation.

16- O raquitismo induzido

principalmente ao uso de

por

medicamentos

est

relacionado

b) anticonvulsivantes
DRUG-INDUCED RICKETS
Certain antiepileptic medications have been known to produce rachitic changes
in children.[16,110,348] Seizure medications that affect the liver may induce the P450 microsomal enzyme system and decrease levels of vitamin D. Hypocalcemia
develops, which can aggravate the seizure disorder. Treatment with vitamin D is
very helpful. The condition should be suspected in neurologic patients with
seizures who begin sustaining frequent fractures.[280,281]
Fonte: Herring: tachdjian's pediatric_orthopaedics 4th edition. Pag 1921
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17. A leso de MONTEGGIA com fratura do tero mdio ou proximal da
ulna e fratura-luxao posterior da cabea do rdio, classificada por
BADO como tipo:
d) 4
Bado suggested classification into four types (Fig. 57-81): type 1, fracture of the
middle or proximal third of the ulna with anterior dislocation of the radial head
and characteristic apex anterior angulation of the ulna; type 2, fracture of the

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

Fonte: Canale e Beaty: Campbells Operative Orthopaedics 12th ed. 2886pg

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18. Na deformidade em botoeira, a imobilizao para o tratamento
conservador deve manter a IFP em extenso e a IFD:
a) livre
Buttonhole deformities that are diagnosed early in closed wounds before fixed
contractures occur can be treated conservatively. If the patient can show some
active extension of the proximal interphalangeal joint, this suggests that an
incompletely ruptured central slip may be present. Conservative treatment
consists of splinting the proximal interphalangeal joint in full extension while
permitting the distal interphalangeal joint to be actively flexed.
Fonte: Fonte: Canale e Beaty: Campbells Operative Orthopaedics 12th ed.
3294pg
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19. A capsulite adesiva do ombro tem maior incidncia em:
b) mulheres com mais de 50 anos.
The incidence of frozen shoulder in the general population is approximately 2%,
but several conditions are associated with an increased incidence, including
female gender, age older than 49 years, diabetes mellitus (five times more),
cervical disc disease, prolonged immobilization, hyperthyroidism, stroke or

myocardial infarction, the presence of autoimmune diseases, and trauma.

Individuals between ages 40 and 70 are more commonly affected.
Fonte: Canale e Beaty: Campbells Operative Orthopaedics 11th ed. 2625pg
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20. Na leso do anel plvico, as artrias do sistema ilaco interno mais
relacionadas hemorragia so a gltea:
b) superior e a pudenda.
Arterial bleeding usually arises from branches of the internal iliac system, with
the superior gluteal and pudendal arteries being the most commonly identified
source.
Fonte: Rockwood and Greens fractures in adults 7th ed, p1419
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21. No estgio II da insuficincia do tendo do tibial posterior, classificada
por JOHNSON e STROM, encontramos no exame fsico:
c) compensao para inverso do p utilizando o tibial anterior.
Classification systems in general are useful only to the extent that they assist in
planning treatment or in predicting the outcome of the condition. The
classification system originally developed by Johnson and Strom in 1989 is
useful in the management of posterior tibial tendon insufficiency. Stage I disease
is characterized by swelling, pain, inflammation, and often effusion within the
posterior tibial tendon sheath. Irritability is noted with passive eversion of the
foot along the course of the posterior tibial tendon. Mild weakness to manual
testing may be present; however, no deformity of the foot is demonstrated when
compared with the opposite foot. The patient is able to invert the foot actively on
a double-leg toe raise test and is able to perform a single-leg toe raise as
described in the next section. Stage II disease is characterized by the loss of
function of the posterior tibial tendon and inability to perform a single-leg
toe raise. There is attempted compensation by use of the anterior tibial
muscle and tendon unit as an accessory inverter of the hindfoot. In stage II
disease the hindfoot remains flexible. With the hindfoot in neutral the forefoot
can be brought into neutral. Generally, mild lateral or sinus tarsi impingement
pain is present. In
stage III disease function of the posterior tibial tendon is lost. A fixed hindfoot
deformity with valgus abduction occurs and degenerative changes may be
apparent on radiographs. Significant lateral sinus tarsi pain is present. Stage IV
disease was described by Myerson et al. and involves valgus positioning and
incongruency of the ankle joint in addition to stage III findings.
Fonte: Canale e Beaty: Campbells Operative Orthopaedics 12th ed. 3908pg

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22. Na fratura do antebrao da criana que ocorre por mecanismo indireto,
os segmentos mais vulnerveis ao trauma no rdio e na ulna so,
respectivamente:
a) transio mdio-distal e difise
The primary mechanism of injury associated with radial and ulnar shaft fractures
is a fall on an outstretched hand that transmits indirect force to the bones of the
forearm.3,70,165 Biomechanic studies have suggested that the junction of the
middle and distal thirds of the radius and a substantial portion of the shaft
of the ulna have an increased vulnerability to fracture.
Fonte: Rockwood and Wilkinss fractures in children 7th ed p350
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23. Na pseudartrose aps osteossntese intramedular, o exame de imagem
com maior sensibilidade para o diagnstico a:
d) tomografia computadorizada
No consegui a fonte original citada pelo TARO, mas achei este artigo que
cita a TC com 100% de sensibilidade.
Computed tomography scans displayed very good diagnostic accuracy.
Intraobserver agreement was high (intraclass correlation coefficient = 0.89), the
sensitivity for detecting nonunion was 100%, and the overall accuracy was
89.9%. Computed tomography was limited by a low specificity of 62%, as three
patients who were diagnosed as having tibial nonunion with computed
tomography underwent surgery and were found to have a healed fracture.
Fonte: The accuracy of computed tomography for the diagnosis of tibial
nonunion. J Bone Joint Surg Am. 2006 Apr;88(4):692-7.
Em: http://www.ncbi.nlm.nih.gov/pubmed/16595457
_________________________________________________________________
24. A sndrome de REITER caracteriza-se por
sinovite:

conjuntivite, uretrite e

d) assimtrica no homem
Reiter syndrome is described as a triad of conjunctivitis, urethritis, and synovitis.
The synovitis usually involves asymmetrically four or fewer joints. Heel pain,
back pain, and nail deformities may occur in this syndrome, sometimes making it
difficult to distinguish it from psoriatic arthritis. It affects the lower extremity

more often than the upper, and 90% of patients have remission of symptoms after
several weeks; in about 10% the disease may become chronic. It is typically
found in young men. Surgery rarely is indicated.
Fonte: Canale e Beaty: Campbells Operative Orthopaedics 12th ed. 3558pg
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25. Na fratura diafisria do fmur, a fixao interna com placa pela via
aberta est mais bem indicada na presena de:
d) fratura ipsilateral do colo do fmur
Fonte: Rockwood and Greens fractures in adults 7th ed, p1668

_________________________________________________________________

26. A fratura do colo do fmur mais frequente na criana, segundo a

classificao de DELBET & COLONNA, corresponde ao tipo:
b) II
Type II Transcervical fractures are the most common fracture type (45% to
50% of all femoral neck fractures),50 occur between the physis and are above the

intertrochanteric line, and by definition are consider intracapsular femoral neck

fractures.
Fonte: Rockwood and Wilkinss fractures in children 7th ed p772
_________________________________________________________________
27. O granuloma eosinoflico em apresentao isolada encontrado mais
frequentemente:
a) no crnio e no fmur
About two thirds of cases are diagnosed in individuals younger than 20 years of
age, with most diagnoses made in the 5- to 10-year-old age group. The first
symptom is localizing pain, occasionally accompanied by swelling and lowgrade fever. The erythrocyte sedimentation rate may be elevated. The skull is
the most common site of involvement, followed by the femur. Approximately
40% of solitary eosinophilic granulomas are found at one of these two sites, and
the skull and femur are also most commonly affected in cases with multiple
lesions.
Fonte: Herring: Tachdjians Pediatric Orthopaedics 4th ed, 227pg
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28. No mecanismo da luxao anterior traumtica do quadril, o membro
inferior est posicionado em rotao:
d) lateral e abduo
Anterior dislocations of the hip are uncommon and, according to Epstein,
constitute only 12% of traumatic hip dislocations. They occur with the hip
externally rotated and abducted.
Fonte: Canale e Beaty: Campbells Operative Orthopaedics 11th ed. 3296pg
_________________________________________________________________
29) Na ruptura fechada do tendo calcneo, o mecanismo de leso mais
comum envolve:
D) Flexo dorsal do p com o joelho em extenso.
Most commonly, the mechanisms of Achilles tendon rupture are pushing off
with the weight-bearing forefoot while extending the knee, sudden unexpected
dorsiflexion of the ankle, and violent dorsiflexion of the plantar flexed foot, as in
a fall from a height. Disruption also can occur from a direct blow to the
contracted tendon or from a laceration.
Fonte: Campbell 12th, pg 2321

30) Na mielomeningocele, as fraturas ocorrem frequentemente na

extremidade:
A) Distal do fmur
Patients with myelomeningocele are susceptible to pathologic fractures of the
lower extremities, particularly in the supracondylar femoral and supramalleolar
tibial regions. Risk factors include inattention toward insensate parts by the
patient or caretakers, joint contracture, postsurgical cast immobilization, and
higher levels of paralysis.
Fonte: Tachdjian 5th. pg e136 (1906 do pdf)

31) A Fratura da Clavcula classificada segundo ROBINSON como 3A2

corresponde ao tipo:
C) III de Neer

Fonte: Rockwood adulto 8th pg. 1438

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

A) Do canto
The almost pathognomonic fracture of child abuse is the CML (Classic
Metaphyseal Lesion), commonly termed the corner or bucket-handle
fracture.

Fonte: Rockwood criana 8th. pg 248

33) Na avaliao radiogrfica do acetbulo, a dissociao entre a linha

ilioisquitica e gota de lgrima de Kohler sugerem fratura:
D) Da superfcie quadriltera.
Dissociation of the teardrop and the ilioischial line indicates either rotation of
the hemipelvis, or a fracture
of the quadrilateral surface.
Anteroposterior
(AP)
radiograph of the pelvis.
1, iliopectineal line; 2,
ilioischial line; 3, teardrop;
4, acetabular roof;
5, anterior rim of the
acetabulum; 6, posterior rim
of the acetabulum.

Fonte: Rockwood adulto 8th. pg. 1900

34) A ruptura do tendo do quadrceps mais comumente associada a:

A) Uremia, diabetes e hiperparatireoidismo
Quadriceps rupture is more common in older patients and in patients with
systemic disease or degenerative changes. Systemic diseases, such as lupus
erythematosus, diabetes, gout, hyperparathyroidism, uremia, and obesity, have
been associated with disruption of the quadriceps mechanism. A relationship
between prior steroid injection, as well as use of corticosteroids or
fluoroquinolone antibiotics, and tendon rupture has been documented.
Fonte: Campbell 12th. pg. 2336-2337.

35) Na rigidez ps-traumtica da articulao metacarpofalngica, a

capsulotomia contraindicada se o arco de movimento alcanar:
D) 60
METACARPOPHALANGEAL JOINT
CAPSULOTOMY: When metacarpophalangeal joint motion is 60 degrees,
capsulotomy is contraindicated because only 60 to 70 degrees of motion usually
can be expected after surgery even if the soft tissues around the joint are normal.
Fonte: Campbell 12th. pg 3361 (quadro azul)

36) Na luxao da aticulao acrmio-clavicular do tipo III de Rockwood,

existe integridade dos ligamentos coracoclaviculares quando h fratura:
D) do processo coracoide
Rarely, complete AC dislocation will be accompanied by a fracture of the
coracoid process rather than by disruption of the CC ligaments. Although the
fracture of the coracoid process is difficult to visualize on routine radiographs, its
presence should be suspected because of the presence of a complete AC
separation and a normal CC distance, as compared with the uninjured shoulder.
The ideal radiograph for visualizing the coracoid fracture is the Stryker notch
view.
Fonte: Rockwood adulto 8th. pg. 1585

37 - Na confeco da banda de tenso para tratamento da fratura de

olcrano, a colocao dos fios de KIRSCHNER em posio muito lateral esta
relacionada com:
C) Impacto na Tuberosidade bicipital
Potential Pitfalls and Preventative Measures. Ten- sion-band wiring can be
successful in properly selected patients. To avoid loss of fixation, an anatomic
reduction is necessary and this technique should be used only in simple fracture
pat- terns. Hardware prominence requiring removal is common. To decrease the
incidence of symptomatic hardware, the K-wires should be buried under the
triceps and the cerclage wire knots should be buried as well. If the wires are left
too prominent on the anteromedial aspect of the ulna, median and ulnar nerve
injury is possible. Avoid wires that exit laterally in the region of the biceps
tuberosity to prevent impingement or heterotopic ossification and
subsequent synostosis.

Fonte:Rockwood and Greens

Fractures in Aduldts 8 th ed.
1218 pg.
_________________________________________________________________
38 - O condrossarcoma primrio tem seu pico de incidncia na faixa etria
entre:
C) 40 e 60 anos
Chondrosarcoma constitutes about 9% of primary malignan- cies of bone, an
incidence about half that of osteosarcoma. It is the second most common
nonhematologic primary malignancy of bone. It occurs over a broad age range,
with peaks between 40 and 60 years for primary chondrosarcoma and
between 25 and 45 years for secondary chondrosarcoma.
Fonte: Canale e Bealty: Campbells Operative Orthopedics 12th. 914 pg.

39) No exame fsico da mo, se a articulao interfalngica proximal no

flexiona passivamente com a metacarpofalngica em extenso e flexiona
passivamente com a metacarpofalngica em flexo, deve-se pensar em:
C) Retrao dos msculos intrnsecos.
The proper surgical release of established intrinsic muscle contractures depends
on the severity of the contractures. When the contractures are mild (Fig. 74-9),
the metacarpophalangeal joints can be passively extended completely, but while
they are held extended, the proximal interphalangeal joints cannot be flexed
(positive intrinsic tightness test).
Fonte: Campbell 12th . pg 3620
40) Na fratura do colo do fmur do idoso tratada com reduo anatmica e
fixao interna, o fator mais frequentemente relacionado reoperao a:
B) falha de osteossntese

Although AVN (avascular necrosis of neck) is a well-recognized complication,

the majority of reoperations are performed for early fixation failure in
osteoporotic bone and nonunion.
Fonte: Rockwood adulto 8th. pg. 2047.
41) Na artrogripose, a cirurgia de STEINDLER tem como objetivo a
correo da deformidade em:
D) extenso do cotovelo.
Procedures to Achieve Active Elbow Flexion: Steindler Flexorplasty. The
Steindler flexorplasty produces elbow flexion by transferring the flexor pronator
origin from the medial epicondyle to the anterior humerus. It may be useful if the
muscle can be isolated preoperatively and the wrist can be stabilized against
excess flexion with the radial wrist extensors. Unfortunately, most children with
arthrogryposis lack radial wrist extensors, and this transfer produces
unacceptable wrist flexion unless these extensors are present. Thus this procedure
is rarely indicated.
Fonte: Tachdjian 5th. pg e551 (2320 do pdf)

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

frequncia em:
a) Mulheres, bilateralmente.
Intrapelvic protrusio acetabuli can be primary or secondary. The primary form,
arthrokatadysis (Otto pelvis), involves both hips, occurs most often in younger
women, and causes pain and limitation of motion at a relatively early age.The
secondary form can be caused by migration of an endoprosthesis, septic arthritis,
or prior acetabular fracture. It can be present bilaterally in Paget disease,
arachnodactyly (Marfan syndrome), rheumatoid arthritis, ankylosing spondylitis,
and osteomalacia. The radiographic hallmark of protrusion acetabuli is the
medial migration of the femoral head beyond the ilioischial (Kohler) line. The
deformity may progress until the greater trochanter impinges on the side of the
pelvis. Frequently, there is an associated varus deformity of the femoral neck.
Fonte: Campbell 12th. Pg. 209.

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

C) Fratura do capitato com rotao do fragmento proximal

NAVICULOCAPITATE FRACTURE SYNDROME AND CAPITATE

FRACTURES
Although naviculocapitate fracture syndrome is rare, it should be considered
among the associated injuries that can occur with a fracture of the scaphoid.
Axial compression of a dorsiflexed wrist forces further dorsiflexion, and after the
scaphoid fractures, the dorsal lip of the radius forcefully impacts the head of the
capitate, causing it to fracture. As the wrist continues into further dorsiflexion,
after the scaphoid and the capitate are fractured, the capitate head rotates 90
degrees. The hand, when returned to neutral position, brings the proximal
fragment of the capitate into 180 degrees of rotation. This injury can be
associated with dorsal perilunate dislocation or fractures of the distal end of the
radius. Open reduction is necessary to derotate the capitates fragment. Some
surgeons have excised this fragment, but others have replaced it, reduced the
scaphoid and capitate fractures, and maintained them with internal fixation or
cast immobilization. Osteonecrosis of the capitates may follow such injuries. If
sufficiently symptomatic, osteonecrosis of the capitate may be treated with
excisionalinterposition arthroplasty or midcarpal or capitate-hamate arthrodesis.
Isolated fractures of the capitate are unusual. Nondisplaced fractures of the body
of the capitate are treated nonoperatively. Displaced fractures, especially
fractures involving the joint, usually require open reduction and internal fixation
with Kirschner wires or screws.
Fonte: Campbell 12th. pg 3417

44) A paresiados msculos biceps braquial e extensores radiais do carpo,

assim como a diminuio do reflexo estilo-radial, so caractersticas da leso
da raiz:
B) C6

Fonte: Rockwood adulto 8th. pg 1689

_______________________________________________________________

45. Na ruptura do ligamento cruzado anterior, a largura do tnel

intercondilar menor
D) nas mulheres e interfere na ocorrncia de leso
Referncia: Campbell ed 11

A number of investigators have studied the epidemiology of anterior cruciate

ligamentdeficient knees and have implicated gender and femoral intercondylar
notch width as factors contributing to injury of the anterior cruciate liga- ment.
Numerous investigators have reported that athletes sustaining noncontact anterior
cruciate ligament tears have statistically significant intercondylar notch stenosis.
Souryal and Freeman formulated the notch width index, which is the ratio of the
width of the intercondylar notch to the width of the distal femur at the level of
the popliteal groove measured on a tunnel view radiograph of the knee (Fig. 45101). The normal intercondylar notch ratio was 0.231 0.044. The intercondylar
notch width index for men was larger than that for women. They found
noncontact anterior cruciate liga- ment injuries to be more frequent in athletes
who had a notch width index that was at least 1 standard deviation below the
mean. Shelbourne et al. studied a group of patients who had anterior
cruciate ligament reconstruction and found that women had statistically
significantly narrower notches than men did, but the incidence of tearing the
autograft was the same between groups presumably because a notchplasty
had been performed. Data from the National College Athletic Association
Injury Surveillance System as well as several studies have shown significantly
higher anterior cruciate liga- ment injury rates in female soccer, basketball, and
rugby players than in male players. Possible causative factors for the increased
incidence in women may be extrinsic (body move- ment, muscle strength, shoesurface interface, and skill level) or intrinsic (joint laxity, hormonal influences,
limb align- ment, notch dimensions, and ligament size). Female sex hor- mones
(i.e., estrogen, progesterone, and relaxin) fluctuate radically during the menstrual
cycle and are reported to increase ligamentous laxity and to decrease
neuromuscular performance.
_________________________________________________________________
46. No p torto congnito unilateral tratado pelo mtodo de PONSETI, a
rtese de DENIS BROWNE no p normal deve ser utilizada com rotao
lateral de
A) 40 graus

After removal of the last cast, a foot abduction orthosis (often called a Denis
Browne bar and shoes) is prescribed to prevent recurrence of the deformity, to
favor remodeling of the joints with the bones in proper alignment, and to increase

leg and foot muscle strength. The orthosis consists of two straight-last open-toe
shoes connected by a bar that allows the shoes to be placed at shoulder width
(Fig. 23-47). The bar should hold the shoes at 70 degrees of external rotation
and 5 to 10 degrees of dorsiflexion. In unilateral cases, the normal foot
should be in 40 degrees of outward rotation. Maintaining the feet at
shoulder width facilitates foot abduction. The orthosis is worn full time for at
least 3 to 4 months, and afterward it is worn at nap and nighttime for 2 to 4 years.
Fonte: Tachdjian 4 ed pag. 1081
_________________________________________________________________
47. Na fratura da difise da tbia, a leso neurolgica mais comum aps
osteossntese intramedular a do nervo
D) fibular comum

A leso neurolgica mais comum aps a osteosstese intramedular de uma

fratura tibial a leso do nervo fibular. Koval et al. Documentaram uma
prevalncia das leses neurolgicas de aproximadamente 30% em uma reviso
retrospectiva de 60 pacientes tratados com uma haste intramedular com
fresagem, mas afirmaram que, na maioria do casos, eram pequenas neuropraxias
sensitivas; 89% dessas leses foram temporrias e ficaram curadas em 3 a 6
meses. No entanto, 2 pacientes em sua srie continuaram a exibir deficincia
nervosa um ano depois do procedimento (nvel de evidncia 4).
Fonte:Rockwood 7 ed pag. 1903
_________________________________________________________________
48. A ruptura da banda sargital do capuz extensor dos dedos da mo ocorre
mais comumente do lado
B) ulnar do dedo mdio
Traumatic Dislocation of the Extensor Tendon at the Metacarpophalangeal Joint
Traumatic dislocation of the extensor tendon toward the ulnar aspect of the
metacarpophalangeal joint occurs most commonly in the long finger. The
dislocation usually occurs as a result of a tear in the proximal radial portion of
the shroud ligament (sagittal bands) and the more proximal fascia as the finger is
suddenly extended against a force, as in a flicking or thumping motion. Ulnar
side disruption with radial displacement of the tendon is rare. More violent
mechanisms may cause collateral ligament and joint surface injury. If seen within
the first few days, this dislocation can be treated effectively with splinting of the
metacarpophalangeal joint and wrist in extension for about 3 to 4 weeks,
followed by 3 to 4 weeks of removable splinting or buddy taping to the adjacent
finger on the radial side in the case of ulnar displacement. If the condition goes
undetected and becomes chronic, a repair using a section of the central fibers of

the extensor mechanism at the metacarpophalangeal joint can be successful.

Rayan and Murray described three clinical types of sagittal band injuries (Fig.
63-75): type I injuries show no extensor instability, type II injuries are injuries
with extensor tendon subluxation, and type III injuries have extensor tendon
dislocation. In their series of 28 nonrheumatoid patients, those treated within 3
weeks of injury achieved satisfactory results with nonoperative splinting. Patients
with more severe or chronic involvement frequently required operative treatment
_________________________________________________________________
49. O fator mais importante para a luxao recidivante da patela
D) a competncia do ligamento patelofemoral medial
PATELLA
Recurrent dislocation of the patella can follow a violent initial dislocation, but it
occurs more often in knees with one or more underlying anatomical
abnormalities that predispose the patella to dislocation or subluxation. In these
knees, minor trauma is needed for the initial dislocation to occur. The underlying
pathological condition causes an abnormal excursion of the extensor mechanism
over the femoral condyles. Several anatomical factors should be considered when
evaluating a patient with recurrent dislocation of the patella.
Anatomical studies by Lieb and Berry have shown the contributions of the
various portions of the quadriceps muscle to knee extension. They showed that
the vastus lateralis pulls laterally to the frontal plane of the femur at an angle of 7
to 10 degrees. The vastus medialis is divided into two partsthe vastus medialis
longus (with its muscle fibers pulling at 15 to 18 degrees medially) and the
vastus medialis obliquus (with its muscle fibers pulling at a relatively horizontal
50 to 55 degrees medially). The primary function of the vastus medialis obliquus
muscle is to stabilize the patella against the lateral pull of the vastus lateralis,
making the vastus medialis obliquus the dynamic stabilizer of the patella.
Static factors, the primary stabilizers of the patella, include the shape of the
patella, the femoral sulcus, a patellar tendon of appropriate length, and a
normally tensioned medial capsule reinforced by the patellofemoral and
patellotibial ligaments. The main factor that results in recurrent patellar
dislocation is incompetence of the medial patellofemoral ligament (MPFL).
The MPFL is an extrasynovial ligament, as is the medial collateral ligament.
Injury may result in minimal long-term damage with return of full function,
mild-to-moderate laxity, or incompetence from avulsion or interligamentous
failure with resultant instability. MRI to evaluate the site and extent of injury is
indicated for instability.
_________________________________________________________________
50. Na doena de LEGG-CALV-PERTHES, a subluxao e o achatamento
da cabea femoral ocorrem na fase de
B) fragmentao

Waldenstrm's observation that the clinical course of the disease is variable

remains true today.[351] He observed that although some children experienced
only minor symptoms and minimal changes in the shape of the femoral head,
most had a more severe course, resulting in pain while walking and greater loss
of limb motion. Waldenstrm defined the stages of the disease as shown in Table
17-1. His classification has been modified by most authors to the four stages of
initial, fragmentation, healing (reossification), and residual phases. In a
retrospective study, we found that the time from first radiographic evidence of
disease to the start of fragmentation was a mean of 6 months (range, 1 to 14
months), the fragmentation phase lasted 8 months (range, 2 to 35 months), and
the healing stage occupied 51 months (range, 2 to 122 months).[143]
Clinical findings correspond to some degree with the radiographic stages of the
disease (Table 17-2). During the early stage of the disorder, radiographs show
only increased density of the femoral head, and the patient may experience
recurrent aggravation and alleviation of symptoms and signs. There may be only
mild limp and pain for a time, interrupted by episodes of moderate discomfort
lasting a couple of weeks. During the latter phase, a subchondral fracture is
frequently noted on radiographs (Salter's sign), and the patient's clinical status
may worsen.[307]
Table 17-2 -- Association between Clinical Findings and Radiographic
Stages of Disease
Stage

Clinical Findings

Radiographic Changes

Increased
density
stage

Limp and pain variable, Increased density of femoral

often mild and intermittent
head, with/without subchondral
fracture

Fragmentati Pain and limp may worsen; Head shows fragmentation, may
on stage
may lose range of motion
lateralize and flatten
Reossificati
on stage

Limp and pain gradually Femoral

head
gradually
resolve, range of motion reossifies; flattening of head may
improves
improve

Healed
stage

Occasional limp; occasional May develop

locking, popping
lesion

osteochondrotic

At the beginning of the fragmentation stage, the femoral head starts to

collapse and may extrude from the acetabulum. The patient's limp and pain
are more pronounced, and there is a greater loss of range of motion of the
affected limb. Because the femoral head is deformed, resting the hip usually does
not return normal motion to the joint. In mild cases, where there is minimal
change in the shape of the femoral head, symptoms and signs may be limited.
Patients who have a very brief fragmentation stage are asymptomatic. In more
severe cases, however, clinical symptoms and signs progressively worsen

throughout the fragmentation phase.

The beginning of the healing stage is characterized radiographically by the
development of new bone in the subchondral regions of the femoral head. By this
time, pain and limp have usually started to resolve, but there is still some
limitation of motion. The degree of motion restriction is directly related to the
extent of change in the shape of the femoral head. Usually the child gradually
resumes normal activities without complaints. Symptoms are normally absent as
the femoral head becomes completely reossified.
If reossification in the central segment of the femoral head is significantly
delayed, the patient may begin to experience pain after a number of
asymptomatic years. A loose fragment or osteochondritis dissecans lesion may
subsequently develop in this soft portion of the head. The child complains of
locking and popping of the joint, and crepitus may be present on physical
examination.
Fonte: Tachjian 4 ed.
_________________________________________________________________
51. Na fratura do calcneo tratada pela via lateral estendida, a principal
fonte vascular do retalho fasciocutneo a artria
A) calcaneana lateral

Lateral Approach
The original lateral approach was a standard Kocher approach.62,108,119,121,159 This
approach offered limited access to the body of the calcaneus, often resulted in
scarring of the peroneal tendons, and frequently damaged the sural nerve. In
1984, Fernandez64 first described the extensile posterolateral approach (Fig. 5923A). In this approach, an incision was made halfway between the fibula and
Achilles tendon and starting three fingerbreadths above the tip of the lateral
malleolus. This was extended around the malleolus, following the course of the
sural nerve and small saphenous vein toward the fifth metatarsal
P.2078
base. The sural nerve was identified and protected, and then full-thickness flaps
were developed to bone. After the peroneal tendons were dislocated over the tip
of the malleolus, the calcaneofibular was cut off the calcaneus and then retracted
anteriorly such that the subtalar joint and sinus tarsi were exposed.
Seligson described a very similar incision in a report by Gould82 that same year
(Fig. 59-23B). The goal of the incision was to expose the entire lateral face of the
calcaneus to the level of the calcaneocuboid joint. This approach combines the
posterior approach for the ankle, described by Picot in 1924,162 with a unique
plantar limb that undulated so that the final closure could be tension free. The
incision was made just lateral to the Achilles tendon and carried vertically to the
superior pole of the calcaneus. The incision was then curved gently following a
line where the thinner skin of the lateral side of the hindfoot met the skin of the

heel pad. The incision was carried to the base of the fifth metatarsal. The author
stressed that in the gentle curved portion of the incision, the knife should be
taken straight to bone with the skin, subcutaneous layer, and periosteum kept as a
single layer. The lateral flap was then developed as a single,
P.2079
thick flap. The peroneal tendons were subsequently elevated from the peroneal
tubercle and reflected dorsally, while the calcaneofibular ligament was detached
from the calcaneus. After subtalar capsulotomy, the entire lateral calcaneus,
calcaneocuboid, and subtalar joints were exposed.
Many surgeons reported problems with the sural nerve and with wound healing
using a form of the lateral approach.13,186,243 Borelli21 described the arterial blood
supply of the subcutaneous tissues of the lateral hindfoot and defined the
relationships between these arteries and the lateral extensile incision used for
ORIF of calcaneal fractures (Fig. 59-24). Three arteriesthe lateral calcaneal,
the lateral malleolar, and the lateral tarsal arterywere consistently found along
the lateral aspect of the hindfoot. The lateral calcaneal artery appeared to be
responsible for the majority of the blood supply to the corner of the flap
and, because of its proximity to the vertical portion of the typical incision, it
appeared most likely to be injured from inaccurate placement of the
incision. As a result of this work, and to protect the sural nerve, the authors
recommended that the vertical limb of the incision be started just anterior to the
lateral edge of the Achilles tendon and at the crease of the heel pad and lateral
foot. This study therefore supports the original description of Seligson.82
Fonte: Rockwood 7 ed
_________________________________________________________________
52. O eixo de flexo-extenso do cotovelo no plano lateral encontra-se
A) no centro da trclea
The elbow is composed of two independent uniaxial joints. One is the
humeroulnar joint, which is a hinged, or ginglymoid, joint. The other consists of
the humeroradial and proximal radioulnar articulations, a pivoted, or trochoid,
joint, allowing two degrees of freedom in the elbow joint. Motion in the elbow
involves rotation of the ulna around the humerus during flexion and extension
and rotation of the radius around the ulna during supination and pronation. The
instant center of flexion and extension for the elbow is at the center of concentric
circles formed by the lateral projection of the capitellum and trochlea of the distal
humerus, is about 2 to 3 mm in diameter, and is located in the center of the
trochlea when viewed from the lateral aspect (Fig. 8-34). The axis of rotation of
the elbow lies anterior to the humeral midline and on a line drawn along the
anterior cortex of the humerus. Morrey and Chao found that the carrying angle
varied from 11 degrees of valgus with the elbow in full extension to 6 degrees of
varus with the elbow in full flexion (Fig. 8-35). The joint surfaces slide until the
extremes of full flexion and extension are reached, and then bony impingement
occurs. The transverse axis of rotation of the radiohumeral joint coincides with

the ulnohumeral axis. The longitudinal axis of the forearm passes through the
radial head proximally and the ulnar head distally and is oblique to the
longitudinal axes of the radius and ulna. The normal range of motion of the
elbow is from 0 degrees (full extension) to approximately 150 degrees (full
flexion).
_________________________________________________________________
53) Na artroplastia total do quadril displsico dos tipos 3 e 4 de Crowe, a
principal complicaoo neurolgica a leso do nervo
D) Isquitico

For Crowe type III and type IV hips, femoral length is more problematic. When
the prosthetic socket has been placed in the true acetabulum, the femur must be
translated distally several centimeters to reduce the prosthetic femoral head into
the acetabulum. Often the tissues most limiting this distal translation are the
hamstrings and rectus femoris rather than the abductors. In such cases, a femoral
shortening oste- otomy allows reduction of the femoral head into the true
acetabulum without extensive soft tissue release. Osteotomy of the greater
trochanter and resection of 2 to 3 cm from the proximal femoral metaphysis may
be necessary to permit reduction of the joint without causing undue tension on
the sciatic nerve or fracture of the femoral shaft (Fig. 3-77)
Fonte: Campbell 11 th ed. Pag. 378
_________________________________________________________________
54) No punho reumatoide a leso de Mannerfelt relacionada a ruptura do
tendo do
D) flexor longo do polegar

Although flexor tenosynovitis at the wrist may not be as apparent as that seen on
the extensor surface, the bulk of the tenosynovium interferes with finger motion,
compresses the median nerve in the carpal tunnel, and leads to tendon rupture.
Erosion of the volar capsule and ligaments over radial osteophytes contribute to
flexor pollicis longus rupture in the carpal tunnel (Mannerfelt lesion)
Fonte: Campbell 11 th ed 4218
_________________________________________________________________
55) As leses musculares so mais comuns em msculos:
D) biarticulares e naqueles com predominncia de fibras tipo II

Strains most commonly occur in muscles that cross two joints, in muscles that
have a higher percentage of type II fast-twitch muscle fibers, and in the
weaker muscle of an agonist-antagonist muscle group. One factor contributing to
muscle overload is fatigue, which makes the muscle unable to absorb as much
eccentric force before overload. Another factor that can lead to strain in a muscle
is intrinsic tightness in the muscle, especially in muscles that cross two joints,
such as the hamstrings, the rectus femoris, and the gastrocnemius.
ESTA AFIRMAO EXISTE NO CAMPBELL 11 ed E FOI OMITIDA NO
CAMPBELL 12 ed
Fonte: Campbell 11 th ed. 2747
_________________________________________________________________
56) Uma fratura AO 43A3 com exposio de 3cm e leso isolada da artria
tibial anterior deve ser classificada, segundo gustilo et al, como do tipo
A) II

Fonte: Rockwood 7 th ed. 288

________________________________________________________________
57) No paciente obeso com fratura subtrocantrica de fmur, o implante
mais recomendado :
B) haste intramedular antergrada
Fonte: Jupter J:. Skeletal Trauma 4 th ed. 2021
_________________________________________________________________
58) Na osteognese imperfeita classificada segundo SILENCE, a fragilidade
ssea mais grave no tipo:
B) II

Fonte: Tachdjian 4th. Pg 1947

_________________________________________________________________
59) Na fratura isolada da cabea do rdio classificada por MASON como
tipo II, indicao absoluta de tratamento cirrgico:
A) Restrio da rotao do antebrao
The indications for open reduction and internal fixation remain controversial.
Clear indications include displaced, non- comminuted fractures of the radial head
limit forearm rotation, or radial head fractures fixed as a component of the
surgical repair of an elbow fracture-dislocation. It has been suggested that
fractures displaced greater than 2 mm and involving greater than 30% of the
articular surface (a Type II fracture in the modified Mason classification) might
be best treated with sur- gery; however, this remains unproven.

Fonte: Rockwood adulto 7th. Pg 913-914

_________________________________________________________________
60) A osteomielite hematognica aguda do tero proximal do fmur
apresenta maior possibilidade de evoluo para osteonecrose da epfise na
faixa etria entre:

a) 0 a 18 meses
It is important to bear in mind that continued vigilance is necessary when treating
osteoarticular infections of the large joints in this age category, particularly up to
age 18 months, when long-term sequelae from osteonecrosis and growth
disturbance may result.[16,45,115,135] For this reason, I endorse early aspiration and
surgical debridement of the hip and shoulder whenever sepsis is encountered in
early childhood.
Fonte: Canale & Beaty: Campbell's Operative Orthopaedics, 11th ed.
_________________________________________________________________
61 O teste de McMURRAY para leso meniscal do joelho realizado:
B) de flexo para extenso, em decbito dorsal.
The McMurray test (Fig. 43-37) is probably best known and is carried out as
follows. With the patient supine and the knee acutely and forcibly flexed, the
examiner can check the medial meniscus by palpating the posteromedial
margin of the joint with one hand while grasping the foot with the other
hand. Keeping the knee completely flexed, the leg is externally rotated as far
as possible and then the knee is slowly extended. As the femur passes over a
tear in the meniscus, a click may be heard or felt. The lateral meniscus is checked
by palpating the posterolateral margin of the joint, internally rotating the leg as
far as possible, and slowly extending the knee while listening and feeling for a
click. A click produced by the McMurray test usually is caused by a posterior
peripheral tear of the meniscus and occurs between complete flexion of the knee
and 90 degrees. Popping, which occurs with greater degrees of extension when it
is definitely localized to the joint line, suggests a tear of the middle and anterior
portions of the meniscus. The position of the knee when the click occurs thus
may help locate the lesion. A McMurray click localized to the joint line is
additional evidence that the meniscus is torn; a negative result of the McMurray
test does not rule out a tear.

Fig. 43-37 McMurray test for meniscal injury (see text).

(From Tria AJ Jr: Clinical examination of the knee. In Scott WN, ed: Insall & Scott surgery of the knee, 4th ed,
Philadelphia, 2006, Churchill Livingstone Elsevier.)

Canale & Beaty: Campbells Operative Orthopedics 11th ed. 2424 pg

62 No cordoma sacrococcgeo, o diagnstico radiogrfico dificultado

pela:
A) presena de gs intestinal.
Radiographically, chordomas appear as destructive lesions (Fig. 22-11). They
virtually always arise from the midline. Sacrococcygeal lesions often are missed
on the initial radiographic examination because of overlying bowel gas. They
usually are seen more easily on a lateral view of the sacrum. Likewise,
radioisotope accumulation in the bladder can obscure a sacral tumor on bone
scan. More than 50% of chordomas exhibit radiographically detectable
calcification. CT may be better for detecting calcification (which may help with
the diagnosis), but MRI is better for determining the full extent of the lesion and
its relationship to other anatomical structures. A common pitfall in the evaluation
of a patient with a chordoma and low back pain is ordering an MRI of only the
lumbar spine; this study usually misses a sacrococcygeal chordoma because most
arise below S3.

Fig. 22-11 A and B, Anteroposterior and lateral views of sacrum of patient with
sacrococcygeal chordoma. This lesion could be missed easily because of
overlying bowel gas. C, MRI clearly shows lesion. D, Typical microscopic
appearance of chordoma. Cells with abundant vacuolated cytoplasm
(physaliferous cells) are arranged in cords with mucinous background.
Canale & Beaty: Campbells Operative Orthopedics 11th ed. 914 pg

63 Na artroplastia total de joelho, o corte posterior dos condilos femorais

deve ser feito com:
C) 3 de rotao lateral
Bone Preparation: Bone surface preparation is based on the following
principles: appropriate sizing of the individual components, alignment of the
components to restore the mechanical axis, recreation of equally balanced soft
tissues in flexion and extension, and optimal patellar tracking.
TECHNIQUE 6-2

Make the distal femoral cut at a valgus angle (usually 5 to 7 degrees)

perpendicular to the predetermined mechanical axis of the femur. The amount of bone
removed generally is the same as that to be replaced by the femoral component. If a
significant preoperative flexion contracture is present, remove additional bone from
the distal femur at this time to widen the extension gap.

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

Femoral component rotation can be determined by one of several

methods. The transepicondylar axis, anteroposterior axis, posterior femoral condyles,
and cut surface of the proximal tibia all can serve as reference points.

If the transepicondylar axis is used, make the posterior femoral cut

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

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

Fig. 6-32 Alignment axes in knee with normal condylar shape. Resection
perpendicular to anteroposterior axis (AP) or parallel to epicondylar axis (epi)
results in resection line (x) that is slightly externally rotated relative to posterior
condylar axis (PC). This results in correct positioning of the femoral component.
(From Arima J, Whiteside LA, McCarthy DS, et al: Femoral rotational
alignment, based on the anteroposterior axis, in total knee arthroplasty in a
valgus knee: a technical note, J Bone Joint Surg 77A:1331, 1995.)

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

posterior condylar axis
Canale & Beaty: Campbells Operative Orthopedics 11th ed. 265 pg

64 No ombro, o estabilizador primrio da transio ntrero-posterior da

cabea do mero :
D) o ligamento glenoumeral inferior.
The inferior glenohumeral ligament consists of three different components: the
superior band, the anterior axillary pouch, and the posterior axillary pouch.197
This ligament originates from the anteroinferior aspect of the labrum and extends
to the inferior aspect of the lesser tuberosity. The inferior glenohumeral ligament
complex has been compared to a hammock-like swing that surrounds and
supports the humeral head when the shoulder is abducted.199 As such, this
ligament has been demonstrated to be the primary stabilizer against anterior and

posterior translation of the humeral head, as well as being a restraint against

excessive external rotation of the abducted shoulder.

Rockwood and Greens fractures in Adults 7th ed. 1165-66

65 Na fratura do processo odontide, a fixao com parafuso

contraindicada se houver:
D) trao de fratura de ntero-inferior para pstero-superior.
Indications: Beyond the general surgical indications outlined earlier, anterior
odontoid screw fixation requires additional consideration of several factors.
Concerning fracture pattern, transverse fractures or oblique fractures in which the
fracture line runs from anterosuperior to posteroinferior can be stabilized by an
odontoid screw. Importantly, odontoid screws are contraindicated in fractures
that pass from anteroinferior to posterosuperior, as compression will worsen
fracture displacement (Fig. 42-44). Nearly anatomical reduction is required for
odontoid screw insertion. As screw trajectory is a critical factor, screw insertion
may not be technically possible in patients with barrelshaped chests or

pronounced cervical kyphosis. Odontoid screws are most appropriate for type II
fractures. They should not be considered for type I and most type III fractures.
Some type III fractures that pass through the superior aspect of the C2 vertebral
body (closer to the odontoid waist) are amenable to screw fixation.

Rockwood and Greens fractures in Adults 7th ed. 1350

66 Na incidncia radiogrfica em perfil da escpula, a posio da cabea

do mero em relao ao centro do Y :
D) central.

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

the upper limbs represent the coracoid process and the scapular spine. Scapula
lateral radiograph of a cadaveric scapula (B) highlights the fact that the glenoid
surface lies in the middle of the letter Y. Therefore in these radiographs, the
humeral head should lie directly over the glenoid in the middle of the Y (C).
Fonte: Rockwood and Greens fractures in Adults 7th ed. 991

67 Na displasia do desenvolvimento do quadril diagnosticada tardiamente,

o obstculo intra-articular mais significativo para a reduo :
A) a constrio da cpsula articular.
Late Diagnosis - In the late-diagnosed case, the c:maa.rticular obstacles to
reduction include the contracted adductor longus and the iliopsoas. These
muscles are shortened because of the hip being in the subluxated or dislocated
position, allowing secondary muscle shortening. The intr.wticular obstacles to
reduction in late-diagnosed DDH include the ligamenwm teres, the trans\lerse
acetabular ligament, the constricted anteromedial joint capsule, and, rarely; an
inverted and hypertrophied labrum (32, 120). The most significant intraarticular
obstacle ro reduction, however, is some degree of anteromedial hip capsular
constriction (32, 121-125). The ligamentum teres may be thickened, and it may
become the primary obstacle to reduction in some cases. In children of walking
or crawling age, the ligamentum teres may be significandy elongated and
enlarged. Its sheer bulk precludes concent.ric reduction without excision of the
ligament. The t.tansverse acetabular ligamenrum may hypert.tophy secondary to
the constant pull of the ligamentum teres on its attachment at the base of the
acetabulum (32, 125). This efli:ct
decreases the diameter of the acetabulum.
Fonte: Lovell and Winters Pediatric Orthopaedics 7th ed. 991pg

68 A deformidade em rotao interna dos ossos da perna associada ao

p:
B) torto congnito.
Controversy exists concerning the presence or absence of excessive medial or
internal tibial torsion. Evidence for[76,97,103] and against[27,66,154] this
deformity has been reported, and it is our experience that true medial tibial
torsion can exist in the presence of clubfoot but is generally unusual. More
important is the intra-articular (interosseous) deformity known as medial, or
internal, spin. This deformity, which involves both the talus and the calcaneus
within the mortise, is also a source of controversy.

Fonte: Herring: Tachdjians Pediatric Orthopaedics 11th ed 1103pg

69) Na fratura Toracolombar avaliada segundo a classificao de

distribuio de carga (Load Sharing Classification), a via anterior indicada
quando o somatrio de pontos :
D) > 6

Other classification systems have been developed with the goal of guiding
treatment and providing prognostic information about these injuries. After
reviewing the radiographs and CT scans of 100 thoracolumbar fractures, McAfee
105
et al.
separated these injuries into six discrete groups: wedge-compression,
stable and unstable burst, Chance, flexiondistraction, and trans- lational. With
its emphasis on the mechanism by which the middle column failed, this scheme
was able to determine which type of instrumentation (i.e., distraction or
106
compression) was most suitable for each fracture. McCormack et al.
devised
the load-sharing classification, which uses a grading system to assess
vertebral body comminution, displacement of bony frag- ments, and posttraumatic kyphosis as a means of establishing which injuries may be
appropriately managed with immobiliza- tion alone or short-segment
transpedicular constructs limited to the levels immediately above and below the
fracture site (Fig. 45-13). By identifying cases that were complicated by implant
breakage, the authors suggested that a point total greater than 6 required a
concomitant anterior arthrodesis with a strut graft. The load sharing
classification algorithm has since been vali- dated by both in vitro biomechanical
experiments and other clinical series
Fonte: RW 8 Edio, 1768 p.
_________________________________________________________________
70) A complicao nervosa mais frequente observada na leso de Monteggia
a leso do:
D) Intersseo Posterior
no entanto, o nervo Intersseo Posterior , de longe, o mais comumente
lesionando, especialmente em associao com uma fratura-luxao de
Monteggia
Fonte: RW 7 Edio, 900 p.
_________________________________________________________________
71) Na infeco vertebral, a principal via de disseminao :
A) Hematognica Arterial


Spinal infection can occur by direct infection of the disc itself, usually
through surgical manipulation directly or percutaneously, or by local spread from
contiguous struc- tures. Contiguous spread has been reported to occur from the
colon via subphrenic abscesses and from abdominal abscess extension from
gunshot wounds without direct spinal injury. The most common method of
spinal infection is through the arterial spread of pyogenic bacteria. This
arterially spread infection originates in the end plate of the vertebra, probably in
the venous channels, or in the vertebral body itself and spreads to the disc
secondarily as the infection progresses.
Fonte: Campbell 12 Edio, 1967 p.
_________________________________________________________________
72) Na fratura diafisria proximal do radio, o desvio do fragment superior
ocorre pela ao dos msculos:
D) Supinador e Bceps Braquial

Em fraturas da parte superior do radio, abaixo da insero do supinador e

acima da da insero do pronador redondo, dois msculos robustos (biceps e
supinador) exercem uma fora sem obstculo que promove a supinao do
fragmento radial.
Fonte: RW, 7 Edio, 887 p.
_________________________________________________________________
73) A Doena de Dupuytren caracteriza-se por:
C) Acometer 10x mais os homens

Commonly occurring in adults in their 40s to 60s, Dupuytren contracture

occurs 10 times more frequently in men than in women.
Fonte: Campbell 12 Edio, 3625 p.
_________________________________________________________________
74) Na fratura da extremidade proximal do mero, a complicao mais
comum :
B) Rigidez Articular

The most common complication of proximal humeral fractures is loss

of motion (stiffness). Early physical therapy is associated with improved motion,
but many patients do not recover full motion even with early physical therapy.
Impinge- ment from high-riding tuberosities or subacromial scarring also can
limit motion
Fonte: Campbell 12 Edio, 2851 p.

_________________________________________________________________
75) O padro mais simples de fratura-luxao do cotovelo :
B) Luxao Posterior com Fratura da Cabea do Rdio

O padro mais simples de fratura-luxao do cotovelo a luxao

posterior do cotovelo com fratura da cabea do radio
Fonte: RW 7 Edio, 929 p.
_________________________________________________________________
76) A principal complicao da artroplastia semiconstrita do cotovelo :
B) Soltura

A principal complication of constrained total elbow arthroplasty has been

loosening, usually of the humeral component (Table 12-7). For semi-constrained
prostheses, loosening of the humeral component, previously the most common
cause for revision, has been reduced to less than 5% overall with improvements
in prosthesis design, changes in operative technique, and better understanding of
the anatomy and function of the elbow.

Fonte: Campbell 12 Edio, 575 p.

_________________________________________________________________

77 Na escoliose idiopatica do adolescente, o risco de progress da

deformidade entes da maturidade esqueltica est associado com
C) Acometimento do sexo feminino
Adolescent Idiopathic Scoliosis
Prevalence
The prevalence of radiographic curves measuring at least 10 degrees ranges from
1.5% to 3.0%, that of curves exceeding 20 degrees is between 0.3% and 0.5%,
and that of curves exceeding 30 degrees is between 0.2% and 0.3%. A definite
relationship between idiopathic scoliosis and sex has been noted,
particularly as the magnitude of the curve increases. The ratio of affected
females to males has been reported to be 1 : 1 for curves between 6 and 10
degrees, 1.4 : 1 for curves between 11 and 20 degrees, 5.4 : 1 for curves
exceeding 21 degrees but not requiring treatment, and 7.2 : 1 for curves
requiring orthopaedic intervention. 650 This sex prevalence in idiopathic
scoliosisthat is, an equal prevalence between the sexes for small curves
(<10 degrees), with increasing female prevalence for larger and progressive
curveshas been reported by several authors.29,162,454,650 The clinical
significance of these observations is that curve progression is more common
in girls.
Natural History
Few current natural history studies have examined curve progression in the
untreated, skeletally immature scoliosis population,96,455,534 and consensus is
lacking in the literature regarding the definition of curve progression. Measurable
increases in curve size of 5, 6, and 10 degrees have all been reported as being
representative of progression.* Most studies use increases of more than 5 or 6
degrees as indicative of definite progression.
Fonte: Herring: Tachdjian`s Pediatric Orthopaedics 5th Ed. Pgina 206

78 Na Tibia vara de Blount o Angulo de LEVINE-DRENNAN

A) Pouco confivel quando usado isoladamente
Levine and Drennan measured the tibial metaphysealdiaphyseal angle (MDA),
the angle created by the intersection of a line connecting the most prominent
medial portion of the proximal tibial metaphysis (the beak) and the most
prominent lateral point of the metaphysis with a line drawn perpendicular to the
long axis of the tibial diaphysis (Fig. 22-5). Blount lesions visible on radiographs
subsequently developed in 29 of 30 patients whose MDA was greater than 11
degrees, whereas such changes developed in only 3 of 58 patients with an
angulation of 11 degrees or less.131 However, subsequent studies measuring the
MDA, the tibiofemoral

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

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

79- Na fratura supracondiliana do mero em extenso, o desvio mais comum

do fragmento distal
D) Posterior e Medial
Extension type: Hyperextension occurs during fall onto an outstretched hand
with or without varus/valgus force. If the hand is pronated, posteromedial
displacement occurs. If the hand is supinated, posterolateral displacement occurs.
Posteromedial displacement is more common. Generally, medial displacement of
the distal fragment is more common than lateral displacement, occurring in
approximately 75% of patients in most series.
Fonte: Rockwood and Wilkin`s fractures in Children 8th ed. Pgina 583

80- A fuso do arco posterior do atlas ocorre na faixa etria entre

A) 3 a 4 anos
Atlas
The atlas ultimately comprises three ossification centers, one for each lateral
mass and one for the body, which does not appear until 1 year of age. The
posterior arches fuse by approximately 3 or 4 years of age, and the lateral masses
fuse to the body at the neurocentral synchondroses at age 7 years 103 (Fig. 11-1).
As a result the final internal diameter of the atlas is present by approximately age
7 years, whereas further growth of the external diameter of the atlas occurs
through appositional bone deposition.
Fonte: Herring: Tachdjian`s Pediatric Orthopaedics 5th Ed. Pgina 167

81 O corte transversal do radio nas suas pores proximal, mdia e distal

respectivamente:
C- Cilndrico, Triangular e Oval
Anatomy
The anatomy of the forearm is responsible for some of the unique features of
fractures of the forearm. Fractures are more common distally for several reasons.
First, although both bones are thick-walled throughout the greater part of their
shafts, the cross section of the radius flattens distally. Proximally, it is cylindric;
it becomes triangular in the midshaft and ovoid distally. This geometric change
produces a structural weakness in the radius that has been shown to fracture first
in both-bone forearm fractures.260 Second, the muscular envelope of the
proximal part of the forearm provides more protection to the underlying bone
than distally, where it becomes tendinous.
Fonte: Herring: Tachdjian`s Pediatric Orthopaedics 5th Ed. Pgina 1333

82 Na sndrome do tnel radial, a compresso do nervo intersseo

posterior ocorre
D) Na origem do msculo extensor radial curto do carpo
According to Spinner, posterior interosseous nerve entrapment is of two types. In
one type, all the muscles supplied by the nerve are completely paralyzed; these
include the extensor digitorum communis, extensor indicis proprius, extensor
digiti quinti, extensor carpi ulnaris, abductor pollicis longus, and extensor

pollicis brevis. In the second type, only one or a few of these muscles are
paralyzed. Entrapment of the posterior interosseous nerve can cause chronic and
refractory tennis elbow. Such entrapment is called radial tunnel syndrome and
can occur at four potentially compressive anatomical structures: (1) the origin of
the extensor carpi radialis brevis, (2) adhesions around the radial head, (3) the
radial recurrent arterial fan, and (4) the arcade of Frohse as the posterior
interosseous nerve enters the supinator
Fonte Oficial: Canale & Beaty: Campbell`s Operative Orthopaedics 11th ed Pag
3981
Fonte Utilizada: Canale & Beaty: Campbell`s Operative Orthopaedics 12th ed
Pag 3100

83- Nas fraturas da metfise proximal da tibia em crianas, a complicao

tardia associada a interposio da pata de ganso
c) Deformidade em Valgo
Recent studies suggest that the postfracture tibia valga is the result of an injury to
the pes anserinus tendon plate. It is suggested that the pes anserinus tethers the
medial aspect of the physis, just as the fibula appears to tether the lateral aspect
of the proximal tibial physis. Multiple authors believe that the proximal tibial
fracture disrupts the tendon plate, producing a loss of the tethering effect.
This, then, may lead to medial physeal overgrowth and a functional
hemichondrodiastasis (physeal lengthening).6,27,29,158,164 Exploration of
the fracture, followed by removal and repair of the infolded periosteum that
forms the foundation of the pes anserinus tendon plate, has been suggested
as an approach that may decrease the risk of a developmental valgus
deformity. This theory is supported by the work of Houghton and Rooker, who
demonstrated that division of the periosteum around the medial half of the
proximal proximal tibia in rabbits induced a valgus deformity. They
hypothesized that the increasing valgus angulation was because of a mechanical
release of the restraints that the periosteum imposes on activity of the physis.71
Fonte Oficial: Skeletal Trauma in Children 5th Pgina 440
Fonte utilizada para a resposta: Fonte: Rockwood and Wilkin`s fractures in
Children 8th ed. Pgina 1141

84 A vascularizao da cabea do femur depende predominantemente dos

vasos capsulares localizados nas regies
d) Superior e Posterior

Injury to the vascular supply of the femoral head is an important factor in hip
dislocations. In adults, the primary blood supply to the head derives from the
cervical arteries. These arteries originate from the extracapsular ring at the base
of the femoral neck (Fig. 48-15). This ring is formed by contributions
from the medial femoral circumflex artery (MFCA) posteriorly and the lateral
femoral circumflex anteriorly.84 The capital vessels traverse the capsule close to
its insertion on the neck and the trochanteric ridge and ascend parallel to the
neck, entering the head adjacent to the inferior articular surface.35,73,78
The superior and posterior vessels, which are derived primarily from the MFCA,
have been shown to be the dominant blood supply to the femoral head.67,70,90
In addition, the MFCA supplies the inferior retinacular branch that runs along the
ligament of Weitbrecht and supplies the inferior medial portion of the femoral
head.67,70,90 In addition to the cervical vessels, a minor contribution to the head
arises from the foveal artery, a branch of the obturator artery that lies within the
ligamentum teres. This artery makes a significant contribution to the epiphyseal
portion of the femoral head vasculature in approximately 75% of hips

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

85) contrindicacao absoluta para artroplastia total do joelho:

d) Recurvato por fraqueza muscular

_________________________________________________________________

86) Na hrnia discal cervical, a compresso nervosa de C6 causa alterao

da sensibilidade no dedo:

d) Indicador
_________________________________________________________________
87) Na doena de SCHUERMANN, o diagnostico mais comum :
a) cifose postural

_________________________________________________________________
88) No p diabtico, segundo a classificacao de WAGNER, a presena de
exposio
de
tendes
corresponde ao
grau:
b) 2

_________________________________________________________________

89) Na fratura do planalto tibial, o acesso pstero-lateral realizado no

intervalo entre os msculos:
d) gastrocnmio
femoral

lateral

bceps

_________________________________________________________________
90) A fratura da tuberosidade da tbia em crianas classificada por SALTERHARRIS como tipo I, corresponde na classificao de WATSON-JONES ao tipo:
d) IV

_________________________________________________________________
91) No hlux rgido, segundo a classificao de COUGHLIN e SHURNAS, a
presena de dor mais constante, moderada diminuio do espao articular e
moderada restrio da mobilidade, corresponde ao grau:

b) 2

_________________________________________________________________

92) O tratamento cirurgico da fratura de coluna vertebral secundaria

osteoporose est indicado na presena de
d) dor refrataria ao tratamento conservador

________________________________________________________________
93) Nas fraturas do tornozelo, considerado parmetro radiografia de boa
reduo o:
d) espao entre a parede medial da fbula e a superfcie da incisura da tbia de
3mm no AP.

_________________________________________________________________
94) Na pesquisa clinica da ruptura do tendo calcneo, pede-se para o paciente em
decbito central e com as pernas fora da mesa de exame que realize a flexo ativa
dos joelhos at 90. Neste momento observa-se a posio do p, se est em flexo
plantar, neutro ou flexo dorsal. este teste foi descrito por:

a) Matles

_________________________________________________________________
95) A Sindactilia da mo ocorre mais frequentemente entre o:

c) 3 e 4 dedos

_________________________________________________________________

96) A doena de Kienbock ocorre mais frequentemente em:

a) Mulheres entre 15 e 40 anos

_________________________________________________________________
97) Nas fraturas difamarias estveis do fmur acima dos 11 anos de idade,
tratamento definitivo recomendado
c) osteossintese intramedular rgida com entrada trocantrica

_________________________________________________________________
98) Na sndrome compartimentar aguda, o coeficiente Delta-P obtido
subtraindo-se a presso
d) intracopartimental da presso arterial diastlica

_________________________________________________________________
99) A fratura do termo distal do rdio na criana tem indicao de
tratamento emergencial quando houver:

d) sndrome aguda do tnel do carpo

_________________________________________________________________
100) A ocorrncia de sndrome compartimentar crnica da perna est
associada presena de

c) hrnia fascial
_________________________________________________________________