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Universidade Federal do Amazonas

Hospital Universitrio Getlio Vargas


Servio de Ortopedia e Traumatologia

TARO 2017 REVISO E GABARITO BASEADO NAS REFERNCIAS

Pesquisado por:

Eduardo Rodrigo Nunes Ditzel, Jaime Souza Cruz Menezes, Luis Felipe Tupinamb Da Silva, Luis Fernando Tupinamb Da Silva,
Marcelo Lins Gomes, Caio Vanderlei Silveira Capelasso, Carmen Renata Teixeira Mancilha, Jorge Enrique Acosta Noriega,
Suammy Da Costa Barros, Tiane Raquel Da Silva Dias, Hildo Alves De Sousa Neto, Joo Henrique Lima De Oliveira Filho, Marcel
Barros Dos Santos, Maryelle Gomes De Oliveira, Shirllane Rodrigues Barros de Azevedo.

Edio e Reviso:
Jos Henrique Peres dos Santos - TEOT - 14847

1. Na fratura do cndilo lateral na criana, o msculo que se mantm preso ao fragmento distal o
A) braquiorradial.
B) extensorulnar do carpo.
C) extensor comum dos dedos.
D) extensor radial longo do carpo.
The fracture line usually begins in the posterolateral metaphysis, with a soft-tissue tear in
the area between the origins of the extensor carpi radialis longus and the brachioradialis
muscle. The extensor carpi radialis longus and brevis muscles remain attached to the distal
fragment, along with the lateral collateral ligaments of the elbow. If there is much displacement, both the anterior and
posterior aspects of the elbow capsule are usually torn. This soft-tissue injury, however, usually is localized to the lateral
side and may help identify a minimally displaced fracture. More extensive soft tissue swelling at the fracture site may
indicate more severe soft-tissue injury, which may indicate that the fracture is unstable and prone to late displacement.

FONTE: Rockwood and Wilkins's Fractures in Children 7th Ed. 535 Pg.

2. A estrutura mais importante para garantir a estabilidade do cotovelo no estresse em valgo a 90 de flexo
A) a cabea do rdio.
B) a cpsula articular.
C) o ligamento colateral lateral.
D) o ligamento colateral medial.
A estabilidade em valgo dividida igualmente entre o ligamento colateral medial, a cpsula anterior e a articulao ssea
com o cotovelo em extenso completa. Em 90 graus de flexo, o ligamento colateral medial proporciona 55% da
estabilidade ao estresse em valgo, com o feixe anterior sendo o estabilizador primrio.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2296Pg.
3. Na gonartrose unicompartimental medial, preconiza-se para o paciente de 50 anos de idade com joelho varo de 25
A) artroplastia total do joelho.
B) osteotomia tibial de adio medial.
C) artroplastia unicompartimental medial.
D) osteotomia femoral de cunha de subtrao lateral.
The indications for proximal tibial osteotomy are (1) pain and disability resulting from osteoarthritis that significantly
interfere with high-demand employment or recreation and (2) evidence on weight-bearing radiographs of degenerative
arthritis that is confined to one compartment with a corresponding varus or valgus deformity.
Contraindications to a proximal tibial osteotomy are (1) narrowing of lateral compartment cartilage space, (2) lateral tibial
subluxation of more than 1 cm, (3) medial compartment tibial bone loss of more than 2 or 3 mm, (4) flexion contracture of more
than 15 degrees, (5) knee flexion of less than 90 degrees, (6) more than 20 degrees of correction needed, (7) inflammatory arthritis,
and (8) significant peripheral vascular disease.
Coventry recommended a medial closing wedge osteotomy to correct valgus deformity; however, if the valgus deformity
is larger than 12 degrees, or if the joint surface tilt of the tibia after osteotomy will be more than 10 degrees, he recommended a
supracondylar medial closing wedge femoral osteotomy instead.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 471Pg.

4. A fratura toracolombar por exploso caracterizada por


A) deslocamento de uma vrtebra sobre outra.
B) aumento da distncia dos processos espinhosos .
C) aumento da distncia interpedicular da vrtebra fraturada.
D) presena de mais de cinco fragmentos da vrtebra fraturada .

As principais caractersticas desta leso so fraturas do corpo vertebral na regio posterior com retropulso de osso em
direo ao canal vertebral e ampliao da distncia interpedicular relativa aos nveis adjacentes.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2296Pg.

5. Na escoliose idioptica do adolescente, uma paciente de 14 anos com menarca h dois anos e ngulo de COBB de 35 deve
A) receber alta ortopdica.
B) ser observada com radiografias seriadas.
C) receber prescrio de colete de MILWAUKEE por dois anos.
D) ser operada com artrodese das vrtebras envolvidas na curvatura.

Curves of 30 to 40 degrees in skeletally mature patients generally do not require treatment, but because studies indicate
a potential for progression in adult life, these patients should be observed with yearly standing posteroanterior radiographs
for 2 to 3 years after skeletal maturity and then every 5 years throughout life.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 1715 Pg.

6. Na deficincia femoral focal proximal, a anomalia congnita mais comumente associada


A) coxa vara.
B) hemimelia fibular.
C) p torto congnito.
D) pseudartrose congnita da tbia.
Fibular deficiency is the most common cause of long bone congenital limb deficiency, when considering that fibular deficiency
often accompanies femoral deficiency. Femoral deficiencies arc the next-most common, with an incidence between 1 in 50,000
and 1 in 200,000 live births. Femoral deficiencies include the spectrum of the congenital short femur with a stable hip joint and a
knee without significant contracture to proximal femoral focal deficiency (PFFD). The prevalence of tibial deficiencies is far less
than either fibular or femoral deficiencies and is reponed to be approximated one per million live births.

FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 1350 Pg.


7. Na pseudartrose congnita da tbia, a deformidade angular caracterstica
A) anterolateral.
B) anteromedial.
C) posterolateral.
D) posteromedial.

Congenital Pseudarthrosis of the Tibia


Definition. Bowing of the tibia that presents at birth typically is either anterior, anterolateral, or posterior medial Anterior tibial
bowing that occurs in association with a deficient or absent fibula is diagnostic of fibular hemimelia.
Posterior medial bowing occurs in association with calcaneovalgus foot deformity and has a good prognosis. In oontr:
ast, anterolateral bowing. which usually presents soon after birth, is typically a progressive deformity which often results
in a psedoarthrosis. Anterolateral bowing associated with congenital pseudarthrosis of the tibia (CP1) is rare (1:140,000), ytt it is
the most common type of congenital pseudarthrosis . Neurofibromatosis occurs in more than 50% of patients with anterolateral
bowing, with or without pseudarthrosis of the tibia. This bowing may be the first clinical manifestation of neurofibromatosis.

FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 1189 Pg.

8. O principal estabilizador esttico da articulao glenoumeral o ligamento


A) coracoumeral.
B) glenoumeral mdio.
C) glenoumeral inferior.
D) glenoumeral superior.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 11th ED. 2213Pg.

9. Para a preveno da sndrome da dor regional complexa aps


fratura do tero distal do rdio, indica-se a administrao diria de
vitamina
A) A.
B) C.
C) D.
D) E.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 13th ED.


2213Pg.

10. Na luxao congnita da cabea do rdio, os desvios mais comuns so


A) anterior e anterolateral.
B) anterior e anteromedial.
C) posterior e posterolateral.
D) posterior e posteromedial.

Congenital radial head dislocation may be bilateral or unilateral (162). It is defined by the din:ction of subluxation or dislocation.
Most congenital dislocations are posterior or posterolateral. It is important to distinguish the congenital dislocation from the
posttraumatic dislocation. Because the condition frequency presents late, this distinction can be confusing (162, 157). This is
especially true for willateral anterior dislocations in otherwise healthy children (163-166). Radiographic criteria have been
established to distinguish this lesion from a chronic, traumatic dislocation. These include a small, dome shaped radial head; a
hypoplastic capitellum; ulnar bowing with volar convexity in the anterior dislocation and dorsal convaity in the posterior
dislocation; and a longitudinal axis of the radius that does not bisect the capitellum.
FONTE (official) : Lovell and Winter's Pediatric Orthopaedics 6th Ed 934 Pg.
FONTE(encontrada): Lovell and Winter's Pediatric Orthopaedics 6th Ed 923 Pg.

11. A fratura em galho verde do olcrano associada fratura do colo do rdio ocorre quando o antebrao e o cotovelo esto,
respectivamente, em
A) pronao e varo.
B) supinao e varo.
C) pronao e valgo.
D) supinao e valgo.

A Monteggia type III fracture pattern is created when a varus force is applied across the extended elbow, resulting in a greenstick
fracture of the olecranon or proximal ulna and a lateral dislocation of the radial head.124 Occasionally, however, the failure occurs
at the radial neck (Monteggia III equivalent) and the radial neck displaces laterally, leaving the radial head and proximal neck
fragment in anatomic position under the annular ligament (Fig. 13-11).70
Rotational forces may fracture the radial neck in young children before ossification of the proximal radial epiphysis. This has
been described only in case reports with a supination force.33,40 Reduction was achieved by pronation of the forearm. Diagnosis of
these injuries is difficult and may require arthrography or an examination under general anesthesia. This injury should be
differentiated from the more commonsubluxation of the radial head (nursemaids elbow), in which the forearm usually is held
in pronation with resistance to supination

FONTE (official): Rockwood and Wilkins's Fractures in Children 7th Ed. 435 Pg.
FONTE(encontrado): Rockwood and Wilkins's Fractures in Children 8th Ed. 481 Pg

12. No p talo vertical, h contratura


A) do tibial anterior.
B) da fscia plantar.
C) do tibial posterior.
D) do flexor longo do hlux.

Pathoanatomy. Autopsy and surgical findings have confirmed consistent pathoanatomic findings in congenital vertical talus (280-
283). Most have found contractures of the tibialis anterior, extensor hallucis longus, extensor hallucis brevis, peroneus tertius,
peroneus longus, peroneus brevis, and the Achilles tendon. The peroneus longus and peroneus brevis may be anteriorly subluxed
over the lateral malleolus, and the posterior tibial tendon may be subluxed anteriorly over the medial malleolus. The severe
plantar flexion of the talus results in contact of only the most posterior aspect of the talar dome with the distal tibial articular
cartilage. There is dorsal extension of the articular cartilage of the talar head to accommodate the proximal articular contact with
the navicular, which is wedge shaped with a hypoplastic plantar segment. The head of the talus generally protrudes below the
posterior tibial tendon, and the calcaneonavicular, or spring ligament, is markedly attenuated. The calcaneus is severely externally
rotated and everted, with its posterolateral border in proximity to the fibula. The sustentaculum tali and anterior facet of the
subtalar joint are exceedingly hypoplastic or absent in the most severe cases. The dorsal capsule of the talonavicular joint is
thickened and contracted.

FONTE (oficial) : Lovell and Winter's Pediatric Orthopaedics 6th Ed 1289 Pg.
FONTE (encontrado) : Lovell and Winter's Pediatric Orthopaedics 6th Ed 1460 Pg.

13. Na sndrome do nervo intersseo anterior, h fraqueza ou paralisia do


A) pronador redondo.
B) flexor radial do carpo.
C) flexor longo do polegar.
D) flexor superficial do indicador.

According to Spinner, the anterior interosseous syndrome can cause various signs and symptoms. Typically, the patient has pain
in the proximal forearm lasting for several hours and is found to have weakness or paralysis of the flexor pollicis longus, the flexor
digitorum profundus to the index and long fingers, and the pronator quadratus. When the patient attempts to pinch, active flexion
of the distal phalanx of the index finger is impossible. Variations from these signs and symptoms usually result from atypical
patterns of innervation. If all of the flexor digitorum profundus muscles are supplied by the anterior interosseous nerve, all of
these muscles are weak or paralyzed. Conversely, if innervation overlaps, and the ulnar nerve supplies the flexor digitorum
profundus to the long finger, this finger is spared. EMG, the Ninhydrin print test, and clinical examination help to differentiate the
syndromes. In well-established lesions, atrophy of the forearm flexor mass and of the thenar muscles may be seen.
FONTE(official): Canale & Beaty: Campbell's Operative Orthopaedics 13th ED. 3111Pg.
FONTE(encontrado): Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 3111Pg
________________________________________________________________________________________________________

14. Na fratura diafisria da clavcula, os desvios tpicos do fragmento lateral so


A) translao inferior e rotao posterior.
B) translao superior e rotao posterior.
C) translao inferior e rotao anterior.
D) translao superior e rotao anterior.

The clavicle is not as important as the scapula in terms of muscle origin, but still serves as the attachment site of several large
muscles. Medially, the pectoralis major muscle originates from the clavicular shaft anteroinferiorly, and the sternocleidomastoid
originates superiorly. The pectoralis origin merges with the origin of the anterior deltoid laterally, while the trapezius insertion
blends superiorly with the deltoid origin at the lateral margin (Fig. 38-18). Muscle attachment plays a significant role in the
deformity which results after fracture: The medial clavicular fragment is elevated by the unopposed pull of the
sternocleidomastoid muscle, while the distal fragment is held inferiorly by the deltoid and medially by the pectoralis major. The
undersurface of the clavicle is the insertion site of the subclavius muscle, which is of little significance functionally but serves as a
soft tissue buffer in the subclavicular space superior to the brachial plexus and subclavian vessels. The platysma or shaving
muscle is variable in terms of thickness and extent, but usually envelopes the anterior and superior aspects of the clavicle and
runs in the subcutaneous tissues, extending superiorly to the mandible and the deeper facial muscles. It is divided during the
surgical approach, and is typically included in the closure of the superficial, or skin/subcutaneous layer.

FONTE: Rockwood and Wilkins's Fractures in Adult 7th Ed. 1108 Pg.
FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 1441 Pg.

15. A sinostose radioulnar ocorre com maior frequncia nas fraturas do rdio e da ulna localizadas no tero
A) distal e operadas por inciso dupla.
B) distal e operadas por inciso nica.
C) proximal e operadas por inciso nica.
D) proximal e operadas por inciso dupla.

FONTE: Rockwood and Wilkins's Fractures in Adult 7th Ed. 535 902 Pg.

16. No paciente com mielomeningocele e escoliose, a rpida progresso da curva vertebral associase a
A) hidrocefalia e meningite.
B) medula ancorada e hidrocefalia.
C) meningite e contratura em flexo dos quadris.
D) contratura em flexo dos quadris e medula ancorada.

Scoliosis typically develops gradually in patients < 1 0 years of age and then increases rapidly with the adolescent growth spurt.
When a curve develops in a child younger than 6 years of age, it may be related to an underlying hydromyelia or a tethered cord
syndrome. Muller et al. (61) found that curve progression was related to size of the curve with curves <20 degrees progressing
slowly. In contrast, curves >40 degree progressed severely and quickly at almost 13 degrees per year.

FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 618Pg.


17. Na ruptura da poro distal do bceps braquial, o diagnstico pelo teste do gancho feito com a tentativa de palpar o tendo
em sua face
A) lateral, com flexo ativa do cotovelo.
B) medial, com flexo ativa do cotovelo.
C) lateral, com flexo passiva do cotovelo.
D) medial, com flexo passiva do cotovelo.
The hook test can be used for the diagnosis of complete biceps tendon avulsions: with the elbow actively flexed and
supinated, the examiner should be able to hook an index finger under a cordlike structure in the antecubital fossa if the tendon
is intact. This test was reported to have 100% sensitivity and specificity; however, the examiner must be sure to hook the lateral
edge of the biceps tendon, not the medial edge, because the lacertus fibrosus might be mistaken for an intact biceps tendon.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2349Pg.

18. O ndice de gravidade da instabilidade glenoumeral (ISIS) inclui


A) gnero e idade no ato da cirurgia.
B) gnero e idade no primeiro episdio.
C) esporte de contato e idade no ato da cirurgia.
D) esporte de contato e idade no primeiro episdio.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2281Pg.

19. Na fratura diafisria do mero tratada com reduo aberta e fixao interna rgida pela via anterolateral, a complicao mais
frequente
A) infeco.
B) refratura.
C) no unio da fratura.
D) paralisia do nervo radial.

COMPLICATIONS
The most frequently reported complication after plate fixation of humeral shaft fractures is radial nerve palsy. When using
an anterolateral (brachialis-splitting) approach, it is essential to ensure that the nerve is not under the implant during plate
application to avoid iatrogenic radial nerve injury.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2855-56Pg.

20. Na doena de DUPUYTREN, os ndulos de GARROD localizam-se na face


A) volar da articulao MF.
B) volar da articulao IFP.
C) dorsal da articulao MF.
D) dorsal da articulao IFP.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 3696Pg.
FONTE (encontrada): Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 3626Pg.

21. Na fratura consolidada da difise da tbia tratada com haste intramedular, a queixa mais comum a dor no local da
A) insero da haste.
B) extremidade distal da haste.
C) insero de parafusos de bloqueio distal.
D) insero de parafusos de bloqueio proximal.
Knee Pain. Pain that persists at the IM nail insertion site after fracture healing is not unusual, especially if any hardware is
prominent or the nail was inserted through the patellar ligament. Skeletal Trauma, Jupiter.

CHAPTER 57. Tibial Shaft Fractures, page 2181.

FONTE Oficial :Jupiter J:. Skeletal Trauma 4th Ed. 2373 Pg.

22. Na fratura da extremidade distal do fmur, a complicao mais comum


A) a pseudartrose.
B) a perda de movimento do joelho.
C) o encurtamento maior que 5 mm.
D) a deformidade angular maior que 5 graus.

FONTE: Rockwood and Wilkins's Fractures in Adult 7th Ed. 3430-31 Pg.

23. Na ruptura do ligamento cruzado anterior do joelho, a fratura de SEGOND corresponde avulso da
A) margem lateral da tbia.
B) margem medial da tbia.
C) eminncia intercondilar.
D) pice da cabea da fbula.
Tambm ocorrem frequentemente leses intra-articulares de tecido mole, tanto aos ligamentos cruzados como aos
meniscos.1168172
Essas leses desempenham certo papel no tratamento das fraturas do plat tibial e sero discutidas mais detalhadamente na
seo Tratamento de leses de tecido mole associadas a fraturas do plat tibial. Certas fraturas perifricas das bordas do plat
tibial so virtualmente patognomnicas de leso a ligamento cruzado e, nesses joelhos lesionados, ser apropriado enfatizar o
tratamento das leses ligamentares, em vez da prpria fratura do plat. Essas fraturas so a fratura de Segond, a fratura de Segond
invertida, fraturas da borda tibial anteromedial e fraturas no local de insero do tendo do semimembranoso.34,40,13s.147

FONTE: Rockwood and Wilkins's Fractures in Adult 7th Ed. 4672-73 Pg.

24. Na fratura-luxao de MONTEGGIA no adulto, os piores resultados so esperados para as leses, segundo BADO, do tipo
A) 1.
B) 2.
C) 3.
D) 4.
Ring and Jupiter reported 83% good and excellent results with open reduction and stable
fixation. Poor results are most frequent in Bado type 2 fractures, which are more complex
injuries with elbow dislocations and fractures of the coronoid and radial head and greater
soft tissue compromise

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2886Pg

25. O trauma do antebrao da criana causado por mecanismo de hiperpronao associa-se fratura
A) transversa isolada do rdio.
B) do rdio e da ulna no mesmo nvel.
C) do rdio e da ulna em nveis diferentes.
D) do rdio com luxao radiulnar proximal.
FONTE: Rockwood and Wilkins's Fractures in Children 7th Ed. 350 Pg.

26. No menisco discoide, segundo a classificao de WATANABE, o tipo que mais comumente se apresenta com ressalto lateral
(snapping) em uma criana de 2 a 3 anos o
A) I.
B) II.
C) III.
D) IV.
Clinical Features
The clinical presentation of a child with this condition depends on the type of discoid meniscus. The discoid meniscus with deficient
peripheral attachments (Type III) presents in a young child of 2 to 3 years of age as a snapping knee syndrome. As the knee is
brought from flexion into full extension, a painless, palpable, and audible snap occurs. The child may also have painless giving way
resulting in unexplained falls. Type I and Type II discoid menisci do not usually present until the child or adolescent actually tears
the discoid meniscus, which is prone to happen due to its large surface area. These patients have joint-line pain and tenderness,
and have an effusion. Catching, locking, and giving way are also suggestive of tears in a discoid meniscus if the location is lateral.
This typically occurs in the middle of the child's 2nd decade of life as the child approaches skeletal maturity, or in early adulthood.
In other respects Type I and Type II discoid menisci are asymptomatic.

Watanabe type I Watanabe type II Watanabe type III

FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 4497 Pg.

27. A leso dos isquiotibiais ocorre mais frequentemente


A) no tendo.
B) no ventre muscular.
C) na juno miotendinea.
D) por avulso da tuberosidade isquitica.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2345Pg.

28. Na fratura-luxao da base do primeiro metacarpo, o desvio em


supinao do segmento distal ocorre pela ao do msculo
A) adutor do polegar.
B) oponente do polegar.
C) abdutor curto do polegar.
D) extensor curto do polegar.

FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 973 Pg.

29. Na sndrome do tnel do carpo, a circulao epineural prejudicada


quando a presso intratnel se d a partir de
A) 5 mm Hg.
B) 10 mm Hg.
C) 15 mm Hg.
D) 20 mm Hg.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 13th ED. 3750Pg.
30. No teste de FROMENT, os msculos do polegar avaliados so
A) adutor e flexor curto.
B) adutor e abdutor curto.
C) oponente e flexor curto.
D) oponente e abdutor curto.

Solicitamos ao paciente que apoie o dorso da mo na mesa de exame e avaliamos o movimento ativo do polegar. Pegamos uma
folha de papel e pedimos ao paciente que a segure na outra extremidade, com a mo que estamos examinando. O paciente
prender a folha entre a polpa do polegar e o lado radial do dedo indicador (pina da chave). Na sequncia, pedimos que segure
firme e lentamente vamos puxando o papel. Quando houver paralisia do nervo ulnar, o paciente fletir a articulao
interfalngica do polegar e usar o msculo flexor longo do polegar como um substituto funcional dos msculos adutor do
polegar e flexor curto do polegar, que se encontram sem funo. Esse o teste de Froment

FONTE: Leite NM, Faloppa F. Propedeutica Ortopdica e Traumatologia 2013 Ed. 135.PG

31. Na imobilizao da mo em posicionamento funcional, as metacarpofalngicas devem ficar em flexo de


A) 30.
B) 45.
C) 60.
D) 90.

Burkhalter Cast. This cast is used to treat metacarpal or phalangeal fractures. The wrist is
placed in 40 degrees of extension
and the metacarpophalangeal joints are placed in 70 to 90 degrees of flexion (Fig. 6-18). The
cast relies on the intact dorsal hood of the fingers acting as a tension band or a soft tissue
hinge. It is usually applied by placing a slab over the dorsum of the forearm and the hand, with
the wrist and fingers in the correct position and then applying a forearm cast to secure the
slab. Finger extension is not permitted by the dorsal slab but some flexion is allowed.

James Cast. In this cast the fingers are kept in the position of function of the hand. The wrist is
maintained at 40 degrees of extension with the metacarpophalangeal joints at 90 degrees and the
interphalangeal joints of the fingers at 70 to 90 degrees. In this position the collateral ligaments of
the metacarpophalangeal joints and the interphalangeal joints are stretched maximally and thus
contractures will not occur (Fig. 6-19). As with the Burkhalter cast, the James cast is in fact a
combination of a slab and a cast. Initially a volar slab is applied to the forearm and hand with the
joints in the correct position. A forearm cast is then applied.

FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 170 Pg.

32. Na classificao anatmica de JEFFERSON, a deformidade de COCK-ROBIN encontrada na fratura multifragmentar


A) do arco anterior.
B) da massa lateral.
C) do arco posterior.
D) do processo transverso.
Lateral mass fractures are generally the result of combined axial loading and lateral compression. If severe enough, the occipital
condyle can settle onto the lateral mass of C2, creating a cock-robin deformity. Unilateral lateral mass sagittal split fractures
have been described by Bransford to occur and led to late cockrobin deformity, significant loss of neck rotation, and severe neck
pain that required traction and occipitocervical fusion, even in the face of an intact transverse atlantal ligament.65

FONTE: Jupiter J:. Skeletal Trauma 4th Ed. 782 Pg.

33. Na coxa vara do desenvolvimento, os movimentos mais limitados so


A) aduo e rotao lateral.
B) aduo e rotao medial.
C) abduo e rotao lateral.
D) abduo e rotao medial.

The range of motion of the hip is reduced in all planes of motion, with limitations of abduction and internal rotation being the
greatest (12, 25). The limitation in abduction is due to impingement of the greater trochanter on the side of the pelvis. The loss
of internal rotation is due to the loss of the femoral neck anteversion that is a feature of developmental coxa vara. As part of the
general clinical examination, other causes of coxa vara should be ruled out, for example, skeletal dysplasias (15, 31).

FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 1223 Pg.

34. A fuso da cartilagem trirradiada ocorre aproximadamente entre as idades de


A) 9 a 11 anos.
B) 12 a 14 anos.
C) 15 a 17 anos.
D) 18 a 20 anos.

Pelvic and Acetabular Development


The pelvis of a child arises from three primary ossification centers: The ilium, ischium, and pubis. The three centers meet at the
triradiate cartilage and fuse at approximately 12 to 14 years
of age (Fig. 25-7).59
FONTE: Rockwood and Wilkins's Fractures in Children 8th Ed. 929Pg.

35. O nervo ulnar, no tnel cubital, passa sob


A) o ligamento transverso.
B) a fscia de OSBORNE.
C) a fscia de STRUTHERS.
D) o ligamento colateral ulnar.

FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 1893 Pg.

36. No osteossarcoma, sinal de mau prognstico a elevao da


A) interleucina 6.
B) protena C reativa.
C) desidrogenase lctica.
D) velocidade de hemossedimentao.
The remainder of the physical examination is normal, except in the rare (<1%) patient who presents with bone metastases or
multiple focal osteosarcoma. One-half of all patients have elevated serum alkaline phosphatase (extremely high serum alkaline
phosphatase values indicate a worse prognosis), and approximately one-fourth of all patients have elevated serum LDH level (an
elevated LDH level also is associated with a worse prognosis).
The rest of the laboratory values for blood and urine are normal.

FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 464 Pg.

37. Na distrofia muscular de DUCHENNE, a fraqueza do quadrceps e do glteo mximo evidenciada pelo sinal de
A) OBER.
B) JACOB.
C) GOWER.
D) MEYERON.
Clinical diagnosis of Duchene muscular dystrophy is established by physical examination, including gait and specific muscle
weakness, and by the absence of sensory deficits.
The upper extremity and knee deep-tendom reflexes are lost early in the disease, whereas the ankle reflexes remain positive until
the terminal phase. A valuable clinical sign is the Gower Sign. The patient is placed prone or in the sitting position on the floor
and asked to rise. This is usually difficult, and the patient may require the use of a chair for assistance. The patient is then asked
to use his or her hands to grasp the lower legs and force the knees into extension. The patients then walks his or her hands up
the lower extremity to compensate for the weakness in the quadriceps and gluteus maximum.

FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 591 Pg.

38. Os tecidos sseo e conjuntivo so formados pela placa


A) lateral do ectoderma.
B) medial do ectoderma.
C) lateral do mesoderma.
D) medial do mesoderma.
The bones and connective tissues of the limbs are formed by lateral plate mesoderm, and the muscles originate from myotome
regions of the somitic mesoderm.

FONTE: Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 951 PG

39. As porcentagens mdias do crescimento fisrio proximal e distal do mero so, respectivamente,
de
A) 60% e 40%.
B) 70% e 30%.
C) 80% e 20%.
D) 90% e 10%.

FONTE: Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 19 PG

40. Na leso do nervo axilar, ocorre hipoestesia no brao nas faces


A) lateral e inferior.
B) medial e inferior.
C) lateral e superior.
D) medial e superior.
Neurovascular injury is unusual but has to be excluded by careful clinical examination. Axillary nerve sensation should be examined
as this is the most frequently affected nerve. Hypoesthesia over the lateral aspect of the proximal arm suggests an axillary nerve
injury.
Theoretically motor function of the axillary nerve can be assessed by palpating the deltoid as the patient attempts to actively
extend, abduct, and flex the shoulder but pain often precludes this.

FONTE: Rockwood and Greens Fractures in adults, 8th Ed, Pg 1346.

41. O percentual de rerruptura do tendo calcneo em atletas, aps o tratamento cirrgico


A) menor que 5%.
B) de 5% a 10%.
C) de 10% a 15%.
D) maior que15%.
...e outros, recomendaram o reparo cirrgico em indivduos atlticos por causa da baixa porcentagem de ocorrncia de nova
ruptura (2% a 3% versus 10% a 30% com o tratamento conservador).

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 11th ED. 2459Pg.
42. Na osteomielite hematognica aguda, a regio metafisria mais acometida por apresentar pequeno nmero de
A) linfcitos.
B) macrfagos.
C) osteoblastos.
D) osteoclastos.
Methapyseal bone adjacent to the Physis is the most common site for AHO to develop. Hobo (32) described vascular loops
presents in the long bone methaphysis that take sharp bends and empty into venous lakes, creating areas of turbulence where
bacteria accumulate and cause infection. Relative absence of tissue macrophages in methapyseal bone adjacent to the physis
appears to contribute to the predilection of osteomyelitis for this location.

FONTE: Lovell and Winters Pediatric Orthopaedics, 7th edition, pg. 371

43. As fraturas do polo proximal do escafoide em crianas ocorrem por avulso do ligamento
A) radiocapitato.
B) escafocapitato.
C) radiossemilunar.
D) escafossemilunar.
A proximal pole fracture may propagate through the interface between newly ossified tissue and the
cartilaginous anlage, or the injury may be strictly through the cartilage. Proximal fractures may cause destabilization of the
scapholunate joint, as the scapholunate interosseous ligament remains attached to the avulsed fragment

FONTE: Rockwood and Wilkins's Fractures in Children 8th Ed. 452 Pg.

44. No alongamento dos membros utilizando fixador externo, os tecidos que apresentam melhor capacidade de metaplasia e
diferenciao esto na seguinte ordem:
A) sseo, muscular, ligamentar e tendneo.
B) sseo, muscular, tendneo e ligamentar.
C) muscular, sseo, ligamentar e tendneo.
D) muscular, sseo, tendneo e ligamentar.
As noted by Ilizarov, all tissues will respond to a slow application of prolonged tension with metaplasia and the
differentiation into the corresponding tissue type. Bone responds best followed by muscle, ligament, and tendons in that order.
Neurovascular structures will respond with gradual new vessels and some degree of nerve and vessel lengthening. However, they
respond very slowly and are intolerant of acute distraction forces

FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 259 Pg.

45. Nas leses da fibrocartilagem triangular, a perfurao central corresponde classificao de PALMER do tipo
A) 1A.
B) 1B.
C) 1C.
D) 1D.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 13th ED. 3526Pg.

46. No trauma raquimedular com choque neurognico, so observadas as seguintes alteraes clnicas
A) bradicardia, dbito urinrio baixo e extremidades frias.
B) taquicardia, dbito urinrio baixo e extremidades frias.
C) bradicardia, dbito urinrio normal e extremidades quentes.
D) taquicardia, dbito urinrio normal e extremidades quentes.
FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 1655 Pg.

47. Na SCIWORA, o mecanismo de trauma mais comum


A) flexo e rotao.
B) flexo e distrao.
C) compresso e rotao.
D) compresso e distrao.
A lap belt used for a child can create a point of rotation about which the spine is flexed with an abrupt stop. This is a
common mechanism for creating both intra-abdominal and flexion distraction spinal injuries.
This scenario has been termed SCIWORA, a phenomenon much more common in children
than adults. It is thought that the flexibility of the immature spine allows spinal column segmental displacements great enough to
lead to SCI without mechanically disrupting the bony and/or ligamentous elements.57 Although these injuries may not be visible
on plain radiographs, nearly all will have some evidence of soft tissue injury of the spine on more sensitive magnetic resonance
imaging (MRI) studies.29 The term
SCIWORA is less relevant in the era of routine MRI, which is now obtained in all patients with possible SCI39 and some have
suggested a new acronym SCIWONA (SCI without neuroimaging abnormality).

FONTE: Rockwood and Wilkins's Fractures in Children 8th Ed. 1159 Pg

48. A hrnia discal que compromete a funo do msculo bceps braquial localiza-se no nvel
A) C3-C4 ou C4-C5.
B) C4-C5 ou C5-C6.
C) C5-C6 ou C6-C7.
D) C6-C7 ou C7-T1.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2296Pg.

49. A infeco por tuberculose na coluna vertebral localiza-se mais frequentemente no


A) arco vertebral.
B) disco intervertebral.
C) tero mdio do corpo vertebral.
D) tero anterior do corpo vertebral.
Skeletal tuberculosis most often affects the spine (308), usually in the anterior third of a vertebral body in the lower
thoracic or the upper lumbar spine. The first lumbar vertebra is most commonly involved, whereas T1 0 infection is most commonly
associated with neurologic deficit (309). Paravertebral abscess formation is characteristic, and calcification developing within the
abscess is almost diagnostic of a tuberculous abscess.
The discs become involved when two adjacent vertebral bodies are affected. The bone lesions in the vertebral bodies are mainly
destructive. This frequently leads to kyphotic deformity, which becomes rigid when chronic. Patients with significant kyphosis
often present with neurologic deficit (310).

FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 409 Pg


50. A fratura por estresse com desvio superior a 2mm, segundo KAEDING-MILLER, classificada como grau
A) I.
B) II.
C) III.
D) IV.

FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 656 Pg.

51. A doena de PAGET na forma poliosttica, o percentual de degenerao sarcomatosa


A) menor que 1%.
B) entre 1% e 5%.
C) entre 5% e 10%.
D) maior que 10%.
Secondary osteosarcomas occur at the site of another disease process. They rarely occur in young patients but constitute almost
half of the osteosarcomas in patients older than age 50 years. The most common factors associated with secondary osteosarcomas
include Paget disease and previous radiation therapy. The incidence of osteosarcoma in Paget disease is approximately 1% and
may be higher (5% to 10%) for patients with advanced polyostotic disease.

FONTE (Oficial): Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 913 Pg.
FONTE (resposta encontrada): Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 912 Pg.

52. A fratura por estresse da base do quinto metatarsiano ocorre na zona


A) I.
B) II.
C) III.
D) IV.
Zone I is the most proximal zone and includes the metatarsocuboid articulation, but it is proximal to the fourth and fifth meta-
tarsal articulation. Fractures in this area are avulsion types of injuries, usually secondary to an inversion injury to the foot. Zone II
extends from zone I to the metaphyseal/ diaphyseal junction and includes the fourth and fifth metatarsal articulation. This is the
area of the true Jones fracture. The mechanism of injury is usually that of a strong abduction force to the forefoot, causing a
bending moment at the metaphyseal-diaphyseal junction. Zone III is the proximal 1.5 cm of the diaphysis and is the area where
stress fractures usually occur.

FONTE (official): Canale & Beaty: Campbell's Operative Orthopaedics 13th ED. 4330Pg.
FONTE (resposta encontrada): Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 4197Pg.
53. A fratura de TILLAUX no tornozelo de uma criana pode ser classificada como
A) SALTER-HARRIS I ou II.
B) SALTER-HARRIS II ou III.
C) SALTER-HARRIS III ou IV.
D) SALTER-HARRIS I ou IV.
FRATURAS DE TILLAUX
Uma fratura especial que ocorre em adolescentes mais velhos originalmente foi descrita por Tillaux. O mecanismo de leso uma
fora em rotao externa com estresse colocada no ligamento tibiofibular anterior, causando avulso da li.se distal da tbia
anterolateralmente (Fig. 36-198). Isso ocorre aps a parte medial da li.se ter se fechado (Fig. 36-199), mas antes da parte lateral
se fechar. A fratura resultante atravs da fise atravessa a epfise e distalmente a articulao, criando uma fratura de Salter-Harris
do tipo III ou IV.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 13th ED. 1550Pg.

54. A artrite reumatoide provoca no retrop uma deformidade em


A) varo.
B) valgo.
C) equino.
D) calcneo.
O retrop e o tornozelo esto envolvidos em 30% a 60% dos pacientes com artrite reumatoide. Deformidades no retrop muitas
vezes so o aspecto mais limitante para a deambulao. Os problemas clnicos mais importantes do retrop reumatoide so
calcanhar em valgo com colapso do arco plantar medial e rotao em um plano axial do antep. Estes problemas podem ser
causados por sinovite, hipertrofia sinovial, ou destruio articular da articulao tibiotalar (tornozelo), subtalar e talonavicular.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 4174Pg.

55. No p cavo, o antep est, em relao ao retrop,


A) pronado.
B) varizado.
C) supinado.
D) valgizado.
The forefoot becomes rigidly pronated in relation to the hindfoot. The tripod effect (48) accounts for the varus
position that the hindfoot must assume during weight bearing due to the fixed pronation of the forefoot. Also contributing to the
varus deformity of the hindfoot is the muscle imbalance between the tibialis posterior, an invertor of the subtalar joint, that
remains strong and the peroneus brevis, an evenor of the subtalar joint, that becomes weak (47). The subtalar joint eventually
becomes rigidly deformed in varus because of contracture of the plantar-medial soft tissues, including those of the subtalar joint
complex. Although the triceps surae does not become contracted in CMf, it does in some of the other diseases that cause cavus.

FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 1395-96 Pg.

56. No tratamento da osteoporose, o uso dos bifosfonados


A) inibe a ao dos osteoclastos.
B) inibe a ao dos osteoblastos.
C) estimula a ao dos osteoclastos.
D) estimula a ao dos osteoblastos.
Bisphosphonates are synthetic pyrophosphate analogues which build into the hydroxyapatite of the skeleton similarly to calcium.
Bisphosphonates are the predominant first-choice drugs for specific treatment of osteoporosis both in women and men.
Bisphosphonates act through preventing the osteclasts from resorbing bone. Alendronate and risedronate are the agents most
studied [6870]. They have significant positive effect on BMD in post-menopausal women, especially after a previous vertebral
fracture.

FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 290 Pg.

57. As mucopolissacaridoses mais frequentes so as sndromes de


A) HURLER e MORQUIO.
B) MORQUIO e HUNTER.
C) HUNTER e SANFILIPPO A.
D) SANFILIPPO A e HURLER.
All the MPS are autosomal recessive except for mucopolysaccharidosis type II (Hunter syndrome), which is X-linked.
The most common MPS are type I (Hurler syndrome) and type IV (Morquio syndrome).

FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 255 Pg.

58. O fibroma no ossificante uma leso que se situa


A) excentricamente na difise.
B) concentricamente na difise.
C) excentricamente na metfise.
D) concentricamente na metfise.
A NOF is a metaphyseal lesion eccentrically located (Fig. 13-20).
This lesion grows into the medullary canal. It is surrounded by a well-defined, sharp rim of sclerotic reactive bone. There
should be no acute periosteal reaction unless there has been a fracture. There may be slighdy increased uptake on the technetium-
99 bone scan. Multiple NOFs occur in approximately 20% of the patients.

FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 448 Pg.

59. A deformidade de MADELUNG mais frequente no sexo


A) feminino e bilateral.
B) feminino e unilateral.
C) masculino e bilateral.
D) masculino e unilateral.
Support for a systemic cause acting locally is provided by the fact that the condition is twice as likely to be bilateral as unilateral
and four times more common in girls than in boys.7

FONTE: Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 408 PG

60. O cisto sseo aneurismtico na coluna vertebral ocorre com maior frequncia na parte
A) anterior do corpo vertebral e acima de 20 anos.
B) posterior do corpo vertebral e acima de 20 anos.
C) anterior do corpo vertebral abaixo de 20 anos.
D) posterior do corpo vertebral abaixo de 20 anos.
Aneurysmal bone cyst (ABC) is rare (incidence approximately 3.2 per million) benign lesion of bone composed of blood filled spaces
separated by connective tissue septa [46]. Histologically these septa are more or less rich in fibroblasts, osteoclast-like giant cells
and newly formed reactive woven bony trabecules. ABC is most common during the first two decades of life (Table 1) and affect
mostly the metaphysis of long bones (femur, tibia and humerus), the pelvis and the posterior elements of vertebral bodies.

FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 1893

61. No osteocondroma, a origem


A) da cartilagem hialina.
B) uma m formao ssea.
C) de pequenos ndulos cartilaginosos.
D) uma alterao do crescimento sseo.
Os condromas so leses benignas fo rmadas por cartilagem hialina. Eles so comuns e todas as faixas etrias so afetadas.
Embora qualquer osso possa ser envolvido, as falanges da mo so o local mais comum.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 928Pg.

62. Na fratura da cabea do fmur PIPKIN I, o tratamento cirrgico indicado a


A) artroplastia total.
B) artroplastia parcial.
C) fixao do fragmento fraturado.
D) resseco do fragmento fraturado.
For isolated Pipkin type I fracture with excellent (less than 1-mm step-off) reduction, closed treatment is recommended. One to 4
weeks of light traction (Bucks skin traction or skeletal traction) followed by touch-down weight-bearing on crutches for 4 weeks
has produced good results in most patients.5,13 If the reduction is not adequate, ORIF with small cancellous21 bioabsorbable or
Herbert20,55 screws is recommended, using an anterior approach. Herbert screws provide less compressive force across large
cancellous surface areas than do standard small-fragment crews.55 In polytrauma cases, ORIF may also be indicated
even when the reduction is good to allow mobilization of younger patients.

FONTE:Jupiter J:. Skeletal Trauma 4th Ed. 1613 Pg.


63. O tratamento ideal para a fixao cirrgica da fratura da difise do fmur, pelo princpio da estabilidade relativa,
A) haste fresada
B) fixador externo
C) haste sem fresar
D) placa percutnea
Definitive treatment of these fractures is operative and options include external fixation, intramedullary nailing (IM) and plating.
A locked intramedullary nail inserted by a reamed technique is the gold standard for the management of femoral fractures.

FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 2678 Pg.

64. Na fratura da epfise proximal da tbia fechada com leso vascular associada, o mecanismo de trauma mais comum
A) o varo.
B) o valgo
C) a flexo.
D) a hiperextenso.
Physeal fractures are often seen after a hyperextension force resulting in the metaphyseal portion of the tibia displacing
posteriorly toward the popliteal artery. Valgus stress can open the physis medially with the bula acting as a lateral resistance force
54
(Fig. 29-1). Rarely, a flexion force can cause a Salter Harris type II or III fracture.

FONTE: Rockwood and Wilkins's Fractures in Children 8th Ed. 1453 Pg.

65. Na fratura diafisria do fmur, o compartimento da coxa com maior risco de evoluir com sndrome compartimental o
A) lateral.
B) medial.
C) anterior.
D) posterior.
Closed so tissue injuries range from minor contusions to major closed degloving injuries and compartment syndrome, as described
19
by Tscherne. With regard to compartment syndrome, the anterior compartment has been found to be the most commonly
affected.

FONTE:Jupiter J:. Skeletal Trauma 4th Ed. 1613 Pg.

66. Nas leses do anel plvico, a presena do sinal de GREY TURNER indicativo de
A) fratura dos ramos.
B) hemorragia retroperitoneal.
C) sndrome de MORELL LAVALLE.
D) leso do trato geniturinrio.
Flank ecchymosis, or the Grey Turner sign, is indicative of retroperitoneal hemorrhage. Careful examination of the patient with a
pelvic ring fracture should be undertaken to include neurovascular assessment of the lower extremities, inspection of the skin to
rule out open wounds, examination of the perineum for ecchymosis or frank blood, and palpation of the soft tissues to assess for
fluctuant areas indicating potential degloving (Morel-Lavallee) injuries.

FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 1801 Pg.

67. Na leso do ligamento colateral lateral do tornozelo do tipo III, o melhor tratamento o
A) cirrgico com reparo ligamentar direto.
B) cirrgico com reforo com aponeurose local.
C) no cirrgico com repouso, gelo e elevao do membro.
D) no cirrgico com imobilizao por 4 semanas sem carga.
Most patients with complete grade III tears obtain good results regardless of the type of treatment. For those patients with
complete tears of the lateral ligaments, functional treatment should be initiated consisting of a short period of protection with
taping or bracing that allows early weight bearing, followed by functional range-of- motion exercises and neuromuscular training
of the ankle.
FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 11th ED. 4218Pg

68. A doena de LEGG-CALV-PERTHES mais comum no sexo


A) feminino e bilateral.
B) feminino e unilateral.
C) masculino e bilateral.
D) masculino e unilateral.
It is more common in boys than in girls by a ratio of4 or 5 to 1 (25). The incidence of bilaterality has been reported as 10% to 12%
(24, 26).

FONTE: Lovell and Winter's Pediatric Orthopaedics 6th Ed 1113 Pg.

69. Faz parte dos critrios de CODMAN para o diagnstico de capsulite adesiva
A) limitao da rotao interna.
B) atrofia dos msculos espinhais.
C) dor prxima ao processo coracoide.
D) incapacidade para dormir sobre o ombro oposto.

FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 1188

70. A fratura do colo do fmur no adulto mais frequente em mulheres da raa


A) negra com ndice de massa corprea > 18,5.
B) negra com ndice de massa corprea < 18,5.
C) branca com ndice de massa corprea > 18,5.
D) branca com ndice de massa corprea < 18,5.
Femoral neck fractures occur most frequently in elderly female patients. They are uncommon in patients younger than
270
60 years. There is some racial variation in the incidence. They are less common in black races and more common in black
234
females than in males. Currently, these fractures are most common in the white populations of Europe and North America.
Modifiable lifestyle risk factors increasing the risk of hip fractures include a low body mass index (<18.5), low sunlight exposure,
low recreational activity, smoking, and alco- hol abuse.

FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 535 Pg.

71. Na fratura do calcneo em lngua com grande desvio, a complicao precoce mais frequente a
A) exposio ssea.
B) sndrome compartimental.
C) necrose da pele posterior.
D) leso do nervo plantar medial.
Skin Necrosis Secondary to Displaced Tongue Fractures.
When a tongue fragment is significantly displaced, pressure on the posterior skin may occur, causing necrosis if
left untreated. Gardner et al.62 recently presented a series of 137 tongue fractures with 21 cases exhibiting posterior skin
necrosis. In those fractures treated emergently with percutaneous reduction and temporary Kirschner wire (K-wire) stabilization,
soft tissue compromise did not occur. The authors concluded that because of the high incidence of posterior skin compromise in
tongue-type calcaneus fractures, consideration should be given to immediate percutaneous reduction and temporary
stabilization, plantarflexion splinting, and close monitoring (Fig. 61-3).

FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 535 Pg.

72. Na luxao patelar intra-articular, a superfcie articular da patela est comumente

A) horizontalizada e voltada para a tbia.


B) horizontalizada e voltada para o fmur.
C) verticalizada e voltada para o cndilo lateral.
D) verticalizada e voltada para o cndilo medial.

INTRAARTICULAR DISLOCATIONS OF THE PATELLA

Intraarticular dislocations of the patella are rare and are of two types. The most common type
is a horizontal intraarticular dislocation of the patella with detachment of the quadriceps tendon; the articular surface of the
patella is directed toward the tibial articular surface (Fig. 60-3).

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 3020 Pg.

73. Na artroplastia total do quadril, durante a cimentao, a complicao que diminuiu consideravelmente com a melhora das
tcnicas de anestesia foi
A) o broncoespasmo.
B) a queda da presso arterial.
C) a trombose venosa profunda.
D) o tromboembolismo pulmonar.

FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 2418

74. A complicao mais frequente aps fratura do captulo umeral a


A) pseudartrose.
B) necrose avascular.
C) consolidao viciosa.
D) diminuio da mobilidade articular.

FONTE:Jupiter J:. Skeletal Trauma 4th Ed. 2373 Pg.

75. Na rizartrose o principal ligamento que se torna incompetente para estabilizar a


articulao acometida o
A) ulnar.
B) dorsal.
C) palmar.
D) intermetacarpal.

FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 1797

76. A pseudartrose congnita da tbia apresenta alterao histolgica


A) no peristeo e composta por neurofibroma.
B) no peristeo e composta por tecido fibroso.
C) na medular ssea e composta por tecido fibroso.
D) na medular ssea e composta por neurofibroma.

Because of their association with either neurofibromatosis or fibrous dysplasia, one might expect these lesions to be found
microscopically in the area of the pseudarthrosis site. Although such a finding has been reported,81 most investigators have
failed to find anything other than thickened fibrous tissue at the pseudarthrosis site,27,44 accompanied by a paucity of vascular
ingrowth.85 The fact that the fibrous constriction lesion is universally present has suggested to some investigators that the
primary pathologic lesion is in the periosteal structures around the tibia rather than in the bone itself.1,2

FONTE (OFICIAL) : Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 542 PG


FONTE (CORRIGIDA) : Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 742 PG

77. Na deformidade de SPRENGEL, o tratamento cirrgico deve incluir a resseco do osso omovertebral de modo
A) subperiosteal e depois dos 3 anos de idade.
B) subperiosteal e antes dos 3 anos de idade.
C) extraperiosteal e depois dos 3 anos de idade.
D) extraperiosteal e antes dos 3 anos de idade.
Surgery is indicated in children with severe aesthetic and functional limitations. Surgery does not correct the scapular hypoplasia
but is indicated for improving shoulder motion by restoring more normal positioning of the scapula and the glenoid. This often
consists of excising any omovertebral connections and surgically derotating and
caudally relocating the scapula. Most of the procedures that are described include extraperiosteal resection of the superior
pole of the scapula (130, 132). Subperiosteal resection is associated with a high rate of recurrence (133, 134). In
addition to functional indications for surgery, most patients and families welcome the improvement in the appearance
of the neck line.
In the mild deformities, extraperiosteal excision of the superior pole of the scapula and any omovenebral connections
alone may be satisfactory treatment. In the moderate and severe deformities, the scapula is also derotated and
moved more distally in order to bring the glenoid into a more vertical orientation. The purpose of surgery is to improve
the neck contour along with shoulder motion and function.
Indications for functional improvement have been cited for preoperative abduction <110 to 120 degrees (129, 135).
Surgery is recommended most often in patients between 3 and 8 years of age (136-138).

Fonte: FONTE: Lovell and Winter's Pediatric Orthopaedics 7th Ed 914 Pg.

78. Na marcha normal, as fases de balano e de apoio ocupam o ciclo, respectivamente, em


A) 70% e 30%
B) 30% e 70%
C) 40% e 60%
D) 60% e 40%
The gait cycle is divided into two phases, stance and swing. Stance phase occupies 60% of the gait cycle and swing phase
occupies 40%

FONTE: Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 71 PG

79. A sndrome de SINDING-LARSEN-JOHANSSON acomete com maior frequncia


A) meninas entre 6 e 10 anos.
B) meninos entre 6 e 10 anos.
C) meninas entre 10 e 14 anos.
D) meninos entre 10 e 14 anos.
A Sndrome de SINDING-LARSEN-JOHANSSON uma osteocondrose juvenil que se apresenta com mais frequncia em
adolescentes meninos, entre os 10 e 14 anos. Afeta o polo inferior da patela, na insero proximal do tendo patelar.

FONTE: Siznio e Hebert 2017 Ed. 1114 Pg.

80. No exame fsico do joelho, so manobras indicadas para a avaliao de leses


meniscais os testes de
A) GODFREY e CLARKE.
B) STEINMANN e CLARKE.
C) MCMURRAY e GODFREY.
D) STEINMANN e MCMURRAY.
FONTE: Tarcsio et. Al Exame Fsico 2. Ed. 256-57 Pg.

81. A localizao clssica da osteocondrite dissecante do joelho do adolescente a rea


A) medial do cndilo femoral lateral.
B) medial do cndilo femoral medial.
C) lateral do cndilo femoral lateral.
D) lateral do cndilo femoral medial.
Osteochondritis dissecans of the knee is characterized by the presence of an area along the femoral articular surface
consisting of cartilage and bone that may be softened or may become loose and separated from the resto f the femoral condyle.
Most lesions are located on the lateral side of the medial femoral condyle and range in size from a few milimeters to 2 to 3
centimeters in diameter.

FONTE: Herring: Tachdjian's Pediatric Orthopaedics 5th Ed. 694 PG

82. No tratamento da fratura subtrocantrica com reduo adequada, o colapso em varo menos frequente usando-se
A) DCS.
B) placa angulada.
C) haste intramedular.
D) placa trocantrica bloqueada.
O pilar do tratamento para fraturas subtrocantricas do fmur a haste intramedular. H evidncias de que os implantes
intramedulares so superiores aos implantes extramedulares no tratamento da maior parte das fraturas nessa difcil regio

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 2137Pg.

83. Nas leses fisrias da extremidade proximal do mero do tipo II de SALTERHARRIS, o fragmento metafisrio tem como
localizao mais frequente a regio
A) anterolateral.
B) anteromedial.
C) posterolateral.
D) posteromedial.
This anatomic characteristic, in addition to the relative thickness of the posteromedial periosteum and thinness of the
anterolateral periosteum, may help explain the tendency for the metaphyseal fragmente to buttonhole the periosteum
anterolaterally when the proximal end of the humerus is fractured and (in Salter-Harris type II injuries) for a small posteromedial
piece of metaphysis to stay with the proximal fragment.

FONTE:Jupiter J:. Skeletal Trauma 5th Ed. 257-58 Pg.

84. A fratura diafisria do mero na criana mais frequentemente encontrada na faixa etria entre
A) 0 e 3 anos.
B) 3 e 6 anos.
C) 6 e 9 anos.
D) 9 e 12 anos.
The humeral shaft is fractured less frequently in children that in adults. Among the humeral shaft fractures of childhood,
diaphyseal fractures are more common in children older than 12 or younger than 3 years.

FONTE:Jupiter J:. Skeletal Trauma 5th Ed. 263 Pg.


85. Nas fraturas da difise do fmur em crianas, o desvio do fragmento proximal se d em
A) flexo, aduo e rotao lateral.
B) flexo, abduo e rotao lateral.
C) extenso, aduo e rotao medial.
D) extenso, abduo e rotao medial.

A: In the resting unfractured state, the positionof the femur is relatively neutral because of
balanced muscle pull. B: In proximal shaft fractures the proximal fragment assumes a
position of flexion (iliopsoas), abduction (abductor muscle group), and lateral rotation (short
external rotators). C: In midshaft fractures the effect is less extreme because there is
compensation by the adductors and extensor attachments on the proximal fragment. D:
Distal shaft fractures produce little alteration in the proximal fragment position because most muscles are attached to the same
fragment, providing balance. E: Supracondylar fractures often assume a position of hyperextension of the distal fragment because
of the pull of the gastrocnemius.
FONTE: Rockwood and Wilkins fractures in children 8th Ed. 990 Pg.
86. O msculo vasto lateral inervado e vascularizado, respectivamente, pelo nervo
A) femoral e artria femoral profunda.
B) obturador e artria femoral profunda.
C) femoral e artria femoral superficial.
D) obturador e artria femoral superficial.

FONTE: European Surgical Orthopaedics and Traumathology The EFORT Textbook 2014 Ed. 2664Pg.

87. A complicao mais frequente aps amputao nos membros superiores


A) falha da miodese.
B) contratura articular.
C) ossificao heterotpica.
D) dor do membro fantasma.
Pain Management in the Upper Extremity Amputation
Chronic pain is a frequent complication of traumatic upper extremity amputations. The prevalence of pain in the residual
limb after upper extremity amputation is reported in 7% to 49% of patients. Phantom limb pain is reported in 30% to 79% of upper
extremity amputees, with most authors reporting greater than 50% prevalence.23,50-55 Despite this, chronic pain has not been
shown to significantly impact functional prosthetic wear or return to employment as one might expect.37
FONTE: Jupiter J:. Skeletal Trauma 5th. 2519 Pg.

88. A ossificao do fmur e da tbia ocorre durante a gestao nas semanas


A) 5 e 6.
B) 7 e 8
C) 9 e 10.
D) 10 e 11.
FONTE: Lovell and Winters Pediatric Orthopaedics 7Ed. 9Pg.

89. No tratamento cirrgico do p plano, a artrorrise um procedimento caracterizado pelo


A) bloqueio definitivo da articulao subtalar.
B) bloqueio temporrio da articulao subtalar.
C) bloqueio definitivo da articulao talonavicular.
D) bloqueio temporrio da articulao talonavicular.
Arthroereisis. Arthroereisis of the subtalar joint, using a silicone or Silastic implant, has been reported as an alternative to more
complex joint reconstruction. The rationale of the procedure is to limit the amount of valgus motion in the subtalar joint by using
an interposition peg. Long-term results of this procedure are lacking, and because of potential complications of intraarticular
placement of Silastic material, especially in the normal cartilaginous surfaces of a childs hindfoot, this procedure is not
warranted given that the natural history of a flexible flatfoot is generally benign.1,20,39,41 Nevertheless, the use of silicone or
Silastic material interposed in the subtalar joint is common in the podiatric literature.1,21,35,39 The potential for synovitis
necessitating implant removal is real (Fig. 23-32).

FONTE: Herring: Tachdjians Pediatric Orthopaedics 5th. 780 Pg.

90. A supinao do p envolve movimentos de


A) aduo, inverso e flexo.
B) abduo, everso e flexo.
C) aduo, inverso e extenso.
D) abduo, everso e extenso.

FONTE: Tarcisio et.al Exame Fsico 2 ed 269 Pg.

91. Na leso fisria traumtica, o aparecimento das linhas de HARRIS representa


A) consolidao viciosa.
B) retarde de consolidao.
C) acelerao do crescimento.
D) retarde ou parada do crescimento.
Harris is credited with the first radiographic observation of bony striations in the metaphysis of long bones.123 These
Harris growth arrest lines are transversely oriented condensations of normal bone and are thought to represent slowing or
cessation of growth corresponding to times of illness, injury, or healing. They may be present in a single bone after an isolated
traumatic injury or in all long bones after a significant systemic illness. When present after a physeal injury, they serve as an
effective representation of
the health of the physis

FONTE: Herring: Tachdjians Pediatric Orthopaedics 5th. 1203 Pg.

92. Na leso plvica da criana, a presena de fratura bilateral dos ramos pbicos, segundo a classificao de TORODE e ZIEG,
corresponde ao tipo
A) I.
B) II.
C) III.
D) IV.
R= In their 1985 report on a series of 141 pelvic fractures, Torode and Zieg improved on the Watts classification and expanded it
as follows:
Type Iavulsion fractures
Type IIiliac wing fractures
Type IIIsimple ring fractures, including pubic symphysis diastasis without disruption of the posterior SI joint
Type IVany fracture pattern that creates a free bony fragment, including bilateral pubic ramus fractures, fractures of the anterior
pelvic ring with an acetabular fracture, and pubic ramus fractures or pubic symphysis disruption with a fracture through the
posterior bony elements or disruption of the SI joint

FONTE: Skeletal Trauma in Children 5th ed. 316 Pg

93. Na luxao traumtica irredutvel do joelho, as estruturas mais comumente interpostas so


A) os tendes da pata de ganso.
B) a cpsula e o ligamento colateral tibial.
C) a cpsula e o ligamento colateral fibular.
D) o trato iliotibial e o tendo do bceps femoral.

The examiner should carefully examine the skin for lesions that may give clues to the nature of the injury, such as
prepatellar abrasions consistent with a dashboard injury. Rarely, incarceration of the medial capsule and even the medial
collateral ligament (MCL) can prevent concentric reduction of the joint. In this case, the examiner may be alerted to the presence
of an irreducible dislocation by the presence of skin dimpling on the medial aspect of the knee. Such cases require immediate
open reduction

FONTE: Rockwood and Wilkins's Fractures in Adult 8th Ed. 2372 Pg.

94. Na anatomia da coluna vertebral, a artria de ADAMKIEWICZ est localizada mais frequentemente entre os nveis
A) T7-T9 e direita.
B) T9-T11 e direita.
C) T7-T9 e esquerda.
D) T9-T11 e esquerda
Artery of Adamkiewicz. The artery of Adamkiewicz is the largest of the feeders of the lumbar cord; it is located on the left
side, usually at the level of T9-11 (in 80% of individuals). The anterior longitudinal arterial channel of the cord rather than any
single medullary feeder is crucial. The preservation of this large feeder does not ensure continued satisfactory circulation for the
spinal cord. In principle, it would seem of practical value to protect and preserve each contributing artery as far as is surgically
possible.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 13th ED. 1577Pg.

95. Na consolidao viciosa com deformidade angular tratada com fixao externa circular, a colocao da dobradia no lado
convexo da bissetriz do CORA leva a
A) cunha de abertura.
B) cunha de fechamento.
C) rotao dos fragmentos.
D) translao dos fragmentos.
When the osteotomy plane passes through the convex cortex CORA and an opening wedge angular correction of the
magnitude of deformity is performed, the proximal and distal anatomic and mechanical axes of the bone become colinear, and
normal joint orientation is restored between the distal and proximal joints of that bone. The same correction is achieved when a
closing wedge osteotomy of the magnitude of angulation converges on the concave cortex CORA

FONTE:Jupiter J:. Skeletal Trauma 4th Ed. 2373 Pg.

96. Na osteotomia de CHIARI do quadril, a complicao hemorrgica mais frequente ocorre por leso da artria
A) gltea inferior.
B) gltea superior.
C) circunflexa femoral lateral.
D) circunflexa femoral medial.
Intra-Operative Complications: Stronger bleeding will cease when the osteotomy is medialised. This is due to
haemorrhage from the superior gluteal artery. Bleeding from other major vessels has not yet been reported. Excessive
displacement with central dislocation is extremely unusual. Restoration begins by screwing a femoral head extractor, such as that
used for total hip arthroplasty, into the greater trochanter. It is then pulled laterally under adduction and forced extension of the
leg. After successful re-positioning, the osteotomy is transfixed as described above.

FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 2341
97. Na via de acesso para regio anterior e proximal do antebrao (HENRY), o plano intermuscular encontra-se entre os msculos
braquiorradial,
A) braquial e pronador redondo.
B) braquial e flexor longo do polegar.
C) pronador redondo e flexor profundo dos dedos.
D) flexor profundo dos dedos e flexor longo do polegar.
Aps a inciso de pele e subcutneo, a abertura longitudinal da fscia identifica o intervalo muscular proximal entre o
braquiorradial e o braquial (junto ao tendo do bceps). Distalmente, a disseco continua entre o braquiorradial e o pronador
redondo, que vem descendo de medial para lateral. Retraindo-se o braquiorradial com cuidado, identifica-se o nervo radial j
dividido proximalmente altura do epicndilo lateral em ramo superficial (sensitivo) e ramo intersseo posterior (motor). Esse
ltimo penetra no msculo supinador pela arcada de Frohse

FONTE: Siznio e Hebert 2017 Ed. Parte IV Cap 78 vias de acesso ao membro superior hotsite

98. A amputao do terceiro raio da mo compromete no polegar o movimento de


A) flexo.
B) aduo.
C) abduo.
D) extenso.
Excising the third metacarpal shaft removes the origin of the adductor pollicis and weakens pinch. The index ray should not be
transposed unless this adductor can be reattached elsewhere. The operation is contraindicated if the hand is needed for heavy
manual labor.

FONTE: Canale & Beaty: Campbell's Operative Orthopaedics 12th ED. 724 Pg.

99. Na fratura em galho verde da metfise proximal da tbia, a deformidade mais frequente o
A) varo.
B) valgo.
C) recurvato.
D) antecurvato.
Proximal tibial metaphyseal fractures are relatively uncommon injuries that generally occur in children between 3 and 6 years of
age (range, 1 to 12 years). The male-to-female ratio of approximately 3:1 closely parallels the incidence of tibial fractures by gender
in children. These fractures are typically the result of a direct injury to the lateral aspect of the extended knee. Most of these
fractures have minimal or no displacement and appear benign radiographically; however, they may, in fact, be followed by a
posttraumatic valgus deformity. Greenstick and complete fractures are most commonly associated with a valgus deformity. Such
deformities are unusual
after a torus fracture. In a greenstick fracture, the medial cortex (tension side) fractures while the lateral cortex (compression
side) remains intact or hinges slightly. If the lateral cortex hinges, a valgus deformity occurs.

FONTE: Skeletal Trauma in Children 5th Ed. 439 Pg.


100. Na leso crnica de ESSEX LOPRESTI, indica-se o
A) encurtamento da ulna e resseco da cabea do rdio.
B) encurtamento da ulna e artroplastia da cabea do rdio.
C) alongamento do rdio e reinsero da fibocartilagem triangular.
D) alongamento do rdio e resseco da extremidade distal da ulna.
In chronic and longstanding cases, IOL reconstruction would seem logical, but only in combination with restoration of the
integrity of all forearm stabilizers at the same time as the recreation of a level DRUJ and zero ulnar variance. Restoring this
relationship between radius and ulna may require ulnar shortening osteotomy with simultaneous radial head prosthetic
replacement to prevent further proximal radial migration. Of course, this approach only addresses the skeletal components.

FONTE: European Surgical Orthopaedics and Traumatology - The EFORT Textbook 2014 ED 1546