(Gabarito e Comentários)

RIOT (Residência Integrada de Ortopedia e

Traumatologia) – CEARÁ

Coordenador: Jonatas Brito ([email protected])

Colaboradores (R3):
Diego Frade Fabiana Maria
Ernane Bruno Jones Aguiar
Felipe Rodrigues Ravena Bessa
Guilherme Aguiar Leonardo Lemos
Marcel Rolim Natália Medeiros
Pedro Rafael Max Muller
Ronaldo Sobreira Matheus Pimentel
Morrissy RT, Weinstein SL. Lovell and Winte´s pediatric orthopaedics. 7º ed. Philadelphia:
Lippincott Williams & Wilkins, 2014. 7 Ed. 1391 Pg.
A taxa de recorrência após curetagem de um cisto ósseo aneu- rismático é de 10% a
20%. A recorrência tem sido correlacionada com a idade abaixo de 15 anos, cistos
localizados centralmente e a remoção incompleta do conteúdo da cavidade cística.
Cistos recorrentes podem ser tratados com a mesma abordagem que a lesão primária.

De acordo com o sistema de Watanabe et ai., os meniscos discoides laterais

geralmente são categorizados como completo, incompleto e tipo Wrisberg, com base
no grau de cobertura do platô tibial lateral e a presença ou ausência da inserção
meniscotibial normal posterior. Os tipos completo e incompleto são mais comuns, são
em formato de disco e apresentam um anexo posterior do menisco.
SDT vascular venosa: rara, 1-2% dos casos. Também conhecida como trombose venosa
de esforço ou Síndrome de Paget-Schroetter. Afeta mais adultos jovens. Ocorre uma
trombose espontânea da veia subclávia em decorrência do uso prolongado da
extremidade superior.

Sinal de Urschel
Outras indicações:

Geraldo R Motta Filho, Tarcísio E. P. de Barros Filho. Ortopedia e Traumatologia. 1ªedição. Elsevier,
2017. 1 Ed. 9.7 Pg. 1116.

Geraldo R Motta Filho, Tarcísio E. P. de Barros Filho. Ortopedia e Traumatologia. 1ªedição. Elsevier,
2017. 1 Ed. 7.18 Pg. 990.
Geraldo R Motta Filho, Tarcísio E. P. De Barros Filho. Ortopedia e Traumatologia. 1aedição. Elsevier,
2017. 1 Ed. 7.17 Pg.
Referência Errada:

Referência Correta:
pág: 925

O osteossarcoma parosteal também é um tumor maligno raro e de baixo grau, mas que surge na superfície
do osso e invade a cavidade medular apenas em um estádio tardio. Ele tem uma tendência peculiar a ocorrer
como uma massa ossificada lobulada no aspecto posterior do fêmur distal.

O osteossarcoma periosteal é uma doença maligna de grau intermediário que surge na superfície do osso.
Os locais mais comuns são as diálises do fêmur e da tíbia. Ele ocorre em uma faixa etária um pouco mais
velha e mais ampla.

pag946
Internal fixation of a pathologic fracture through a primary sarcoma may compromise the limb and life
of the patient. If the patient will be treated with preoperative chemotherapy, cast immobilization or
limited internal fixation of the fracture is preferred. The fracture usually heals during systemic
treatment, and a cast avoids potential pin tract infections in neutropenic patients stabilized with an
external fixator.

RMS is a malignant tumor of skeletal muscle. RMS is the most common STS in children with an
approximate annual incidence of approximately 350 new cases in the United States. RMS is slighdy more
common in men and in caucasians. The majority is sporadic. However, some will ocur in association with
neurofibromatosis, Beckwith-Wiedemann syndrome, Li-Fraumeni disease, Costello syndrome, and
others. There are four histologic patterns: embryonal, botryoid type, alveolar and pleomorphic. The
current treatment is a combination of chemotherapy, surgery, and, if the malignancy is not totally
excised, irradiation. When chemotherapy is given preoperatively, the surgery required is less radical and
adequate surgical margins are more easily achieved. If the lesion is small, it should be totally resected
initially. If an RMS lesion occurs in an extremity, preoperative chemotherapy should be considered. A
wide surgical margin is recommended. Regional lymph is sometimes indicated. Preoperative irradiation
is reserved for lesions that would require an amputation in order to obtain a wide margin. Postoperative
irradiation is used when the surgical margins are positive for tumor.
pag 365
Beaty JH, Kasser JR. Rockwood and Wilkins’ Fractures in Children. 8aedição. Philadelphia: Lippincott
Williams & Wilkins, 2015. 8 Ed. 1028 Pg.
Fonte errada:

Fonte correta:
Green Skeletal Trauma Children
Herring JA. Tachdjian’s pediatric orthopaedics. 5º ed. Philadelphia: Saunders, 2014 5 Ed. 1312 Pg.

Beaty JH, Kasser JR. Rockwood and Wilkins’ Fractures in Children. 8aedição. Philadelphia: Lippincott Williams & Wilkins, 2015. 8
Ed. 155 Pg

Beaty JH, Kasser JR. Rockwood and Wilkins’ Fractures in Children. 8aedição. Philadelphia: Lippincott
Williams & Wilkins, 2015. 8 Ed. 770 Pg
Beaty JH, Kasser JR. Rockwood and Wilkins’ Fractures in Children. 8aedição. Philadelphia: Lippincott
Williams & Wilkins, 2015. 8 Ed. 809 Pg

Beaty JH, Kasser JR. Rockwood and Wilkins’ Fractures in Children. 8aedição. Philadelphia: Lippincott Williams &
Wilkins, 2015. 8 Ed. 304 Pg
Geraldo R Motta Filho, Tarcisio E. P. De Barros Filho. Ortopedia e Traumatologia. 1aedição.
Elsevier, 2017. 1 Ed. 1397 Pg.

Browner BD, Jupiter JB, Levine AM, Trafton PG. Skeletal trauma: basic science, management and
reconstruction. 5aedição. Philadelphia: Saunders, 2015. 5 Ed. 442 Pg.
In children 5 to 11 years of age, retrograde flexible intramedullary nailing is generally the safest and best option for
lengthstable fractures (and many length-unstable fractures). Submuscular bridge plating or external fixation is used
for unstable fracture patterns, comminuted fractures, and fractures with severe soft tissue injury. Early spica casting
may be used for nondisplaced or minimally displaced fractures in this age group. In very large or obese children
(greater than 50 kg) who are 9 to 11 years of age, we may use a small diameter locked trochanteric entry
nail.
Referência: Beaty JH, Kasser JR. Rockwood and Wilkins’ Fractures in Children.
8aedição. Philadelphia: Lippincott Williams & Wilkins, 2015. 8 Ed. 1003 Pg.
Ipsilateral Neck and Shaft Fractures
The imaging, identification, and treatment of combined femoral neck and shaft fractures have been a
source of controversy since the first descriptions of the injury pattern. Concomitant femoral neck
fractures occur in 3% to 10% of patients with femoral shaft fractures. Many of the associated
femoral neck fractures are nondisplaced, and missed injuries have been reported in 30% to 57% of cases
(Table 52-21).
Bucholz RW, Heckman JD, Court-Brown CM, Torneta III P. Rockwood and Green’s Fractures in adults.
8aedição. Philadelphia: Lippincott, 2015. 8 Ed. 2199/2200 Pg.

Management of the “Floating Shoulder”

The combination of ipsilateral fractures of the clavicle and scapular neck has
traditionally been called the “floating shoulder,” which has been considered to be an
unstable injury that may require operative fixation.45,145,158,188,191,198,200 In
fact, this injury pattern can be considered to be a subgroup of the “double disruption
of the superior shoulder suspensory complex (SSSC),” a concept introduced by Goss...
Combined scapular (or glenoid neck) and clavicle fractures are the commonest type
of double disruptions of the SSSC, and there remains considerable controversy over
optimal treatment.

Bucholz RW, Heckman JD, Court-Brown CM, Torneta III P. Rockwood and Green’s
Fractures in adults. 8aedição. Philadelphia: Lippincott, 2015. 8 Ed. 1457 Pg.
Canale ST, Beaty JH. Campbell’s operative orthopaedics. 13º ed. Philadelphia:
Saunders, 2017. 13 Ed. 2426 Pg.

Classification

The most common injuries of the tarsal navicular are avulsion, or flake, fractures.102
Acoute navicular fractures are classified into three types: Avulsion fractures, fractures
of the navicular tuberosity, and body fractures102 (Fig. 62-3). The latter occur
predominantly from high-energy trauma and are further subdivided into three
types.293 The Type I body fracture is a horizontal transverse fracture through the
navicular with disruption of the dorsal ligaments

Bucholz RW, Heckman JD, Court-Brown CM, Torneta III P. Rockwood and Green’s
Fractures in adults. 8aedição. Philadelphia: Lippincott, 2015. 8 Ed. 2692 Pg
“The general consensus is toward the use of reamed nailing, but over-reaming must be avoided to
prevent thermal necrosis and infection. Adequate careful reaming allows the use of larger diameter
nails that give better stability with reduced rates of hardware failure. The reamed products also
stimulate osteogenesis at the fracture site which augments fracture healing. In a canine study, Klein et
al.109 documented damage to cortical blood flow of up to 70% in reamed nails but only 31% in
unreamed nails. However, many trials including the SPRINT trial13 and different meta-analyses14 have
not proved any significant superiority of unreamed over reamed nailing in achieving bony union.”

Bucholz RW, Heckman JD, Court-Brown CM, Torneta III P. Rockwood and Green’s Fractures in adults.
8aedição. Philadelphia: Lippincott, 2015. 8 Ed. 379 Pg

“Tibial Shaft Stress Fractures Stress fractures of the tibia represent 20% to 75% of all stress fractures in
athletes.8,16 To effectively treat stress injuries at this anatomical site, a distinction must be made
between medial tibial stress syndrome (shin splints), a compression-sided stress fracture, and a tension-
sided stress fracture. The most predominant type is a low-risk posteromedial cortex (compression side)
stress fracture with the much less common type being the high-risk “dreaded black line” of the
anterolateral cortex of the central shaft (Fig. 21-9A).”
Bucholz RW, Heckman JD, Court-Brown CM, Torneta III P. Rockwood and Green’s Fractures in adults.
8aedição. Philadelphia: Lippincott, 2015. 8 Ed. 661 Pg
“Anderson and D’Alonzo introduced the most common classification for odontoid fractures in 1974 and
divided them into types I through III depending on the location of the fracture line (Fig. 33C-6).35 Type I
fractures are rare and account for approximately 1% of odontoid fractures.36 They represent avulsion
fractures of the alar or apical ligaments at the tip of the odontoid process.”
Browner BD, Jupiter JB, Levine AM, Trafton PG. Skeletal trauma: basic science, 65 management and
reconstruction. 5aedição. Philadelphia: Saunders, 2015. 5 Ed. 849 Pg.

“There are four characteristic mechanisms of primary injury: (1) impact plus persistent compression, (2)
impact alone with transient compression, (3) distraction; and (4) laceration and transection (Table 31-
1).17 Out of those four, the most frequent mechanism of injury involves impact plus persistent
compression.”
Browner BD, Jupiter JB, Levine AM, Trafton PG. Skeletal trauma: basic science, 65 management and
reconstruction. 5aedição. Philadelphia: Saunders, 2015. 5 Ed. 794 Pg.

“A técnica cirúrgica pode ser desafiadora, com a principal complicação sendo o

excessivo preenchimento da articulação radiocapitular levando à erosão, dor e
diminuição do movimento.”
“Uma queda forte sobre a mão espalmada pode resultar em uma fratura da cabeça radial ou colo, lesão
da articulação radioulnar distal e ruptura da membrana interóssea por uma distância considerável
proximalmente.”

Canale ST, Beaty JH. Campbell’s operative orthopaedics. 12º ed. 2878 Pg.

Browner BD, Jupiter JB, Levine AM, Trafton PG. Skeletal trauma: basic science, 65
management and reconstruction. 5aedição. Philadelphia: Saunders, 2015. 5 Ed. 1612
Pg.
POSTERIOR INTEROSSEOUS FLAP
The posterior interosseous artery, usually a branch of the common interosseous artery, supplies a skin
flap territory on the dorsal surface of the forearm. In the distal forearm, the
posterior interosseous artery joins the anterior interosseous artery at the distal part of the interosseous
space. Over its course, the posterior artery gives four to six cutaneous branches, passing through the
septum between the extensor digiti minimi and extensor carpi ulnaris muscles, supplying
an area of skin in about the middle third of the dorsum of the forearm
Canale ST, Beaty JH. Campbell’s operative orthopaedics. 13o ed. Philadelphia: Saunders,
2017. 13 Ed. 3339 Pg.

ZONE TV
Zone TV includes the third extensor compartment and the area of the first dorsal compartment. The
extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus tendons may be injured in
this zone. The superficial radial nerve also is at risk for injury.

Canale ST, Beaty JH. Campbell’s operative orthopaedics. 13o ed. Philadelphia: Saunders,
2017. 13 Ed. 3399 Pg.
A variança ulnar, ou índice radiulnar, mede a relação de comprimento entre o rádio e a
ulna. Em 61%, 1 a cabeça da ulna e a cortical medial do rádio estão no mesmo nível
(variação neutra). A variação ulnar positiva (ulna mais longa ou “ulna plus”) e a variação
ulnar negativa (ulna mais curta ou “ulna minus”) podem ser fisiológicas; portanto,
radiografias comparativas com o lado oposto são necessárias para determinar o
comprimento fisiológico da ulna. O comprimento radial é a medida da distância entre
duas linhas perpendiculares ao longo do eixo do rádio, uma da extremidade distal da
apófise do processo estiloide do rádio e outra da superfície articular da cabeça da ulna,
tendo, em média, 12 mm.

Sizínio K Hebert, Tarcísio E. P. De Barros Filho, Renato Xavier, Arlindo G Pardini Júnior.
Ortopedia e Traumatologia: Princípios e Prática. 5aedição. Artmed, 2017. 5 Ed. 3009 Pg.
The mecanism of lateral process fractures is still controversial. These fractures are
assumed to result from forced pronation or supination of the hindfoot under axial load.
They are also known as “ snowboarder’s ankle”.

European Surgical Orthopaedics and Traumatology The EFORT Textbook Editor George
Bentley Springer Heidelberg New York Dordrecht London 2014. Ed. 3790 Pg.
Neutralization Plating
A neutralization plate is also called a protection plate. The mechanical function of this plate is to protect
a lag screw from bending and torsional forces;

Browner BD, Jupiter JB, Levine AM, Trafton PG. Skeletal trauma: basic science, management and
reconstruction. 5aedição. Philadelphia: Saunders, 2015. 5 Ed. 260 Pg.

LOCKING TECHNIQUE
(…) It is therefore recommended to lock first at the far end, then to backslap the nail, and
finally to lock the driving end. Finally locking can be dine un a static or dynamic mode,
while it is advisable to use at least two locking screws at either end of the nail to control
rotation in a realiable way. Static locking is recommended for complex fractures to
prevent telescoping (...)
Bucholz RW, Heckman JD, Court-Brown CM, Torneta III P. Rockwood and Green’s
Fractures in adults. 8aedição. Philadelphia: Lippincott, 2015. 8 Ed. 222 Pg.
Simple elbow dislocations are typically the result of a fall on an outstretched hand. O’Driscoll described
a valgus, axial, and posterolateral force, that results in the typical posterolateral dislocation of the elbow
joint (Fig. 34-1).81 The soft tissue injury is thought to begin on the lateral side of the elbow with
disruption of the lateral collateral ligament (LCL) and then proceeds through the capsule to the medial
side with the medial collateral ligament (MCL) being injured last. The MCL may remain intact in some
injuries. Less commonly, simple dislocation may be the result of a varus, axial, and posteromedial force
where the injury proceeds from medial to lateral, but this mechanism typically results in a small
anteromedial coronoid fracture, and this injury is discussed later in the chapter.

Canale ST, Beaty JH. Campbell’s operative orthopaedics. 13º ed. Philadelphia: Saunders, 2017. 13 Ed.
2428 Pg.
The lower cervical vertebrae follow a similar pattern of development; the ossification centers at the body and each neural arch
close by the third year, and the neurocentral synchondroses fuse between the fourth and sixth years. (tachidjian’s)
Atlas - The body starts to ossify between 6 months and years, usually in a single center. By 4 to 6 years, the posterior
synchondrosis fuses, followed by the anterior ones slightly thereafter. The final internal diameter of the pediatric Cl spinal canal is
determined by 6 to 7 yean of age.
The dentocentral synchondrosis of C2 begins to close between 5 and 7 years of age (28). However, it may be visible in vestigial
forms up to 11 years of age (35) and may be erroneously intetpreted as an undisplaced fracture. Similarly, the apical odontoid
epiphysis (i.e., ossiculum terminale) may appear by 5 years of age, although it most typically appears around 8 years of age. This
also can be misinterpreted as an odontoid tip fracture. (Lowell)
O áxis tem quatro centros de ossificação separados: um para o dente do áxis (processo odontoide), um para o corpo e dois para os
arcos neurais. As sincondroses neurocentrais conectam o corpo às massas laterais adjacentes e a sincondrose dentocentral o
conecta ao processo odontoide. A sincondrose dentocentral se fecha por volta dos 6 a 7 anos de idade; podendo persistir como
uma linha esclerótica até os 11 anos de idade. (Campbell)
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GABARITO – TARO 2019 – SBOT-CE / RESIDENCIA INTEGRADA
1 A 26 C 51 D 76 D
2 B 27 D 52 B 77 C
3 D 28 D 53 B 78 B
4 A 29 C 54 D 79 B
5 A 30 B 55 A 80 A
6 B 31 A 56 C 81 D
7 D 32 D 57 D 82 D
8 C 33 C 58 B 83 D
9 D 34 B 59 A 84 A
10 C 35 A 60 B 85 C
11 A 36 C 61 B 86 B ou C
12 D 37 A 62 B 87 D
13 B 38 A 63 A 88 A
14 C 39 C 64 D 89 B
15 D 40 B 65 A 90 C
16 D 41 A 66 D 91 A
17 C 42 B 67 D 92 A
18 C 43 D 68 B 93 D
19 B 44 A 69 D 94 C
20 A 45 D 70 A 95 D
21 A 46 C 71 A 96 D
22 D 47 C 72 A 97 B
23 A 48 A 73 B 98 B
24 B 49 A 74 D 99 D
25 B 50 C 75 B 100 D