TARO 2015 CORRIGIDO E COMENTADO

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Universidade Federal do Amazonas 
Hospital Universitário Getúlio Vargas 
Serviço de Ortopedia e Traumatologia 
 
 
 
TARO 2015 – GABARITO BASEADO NAS REFERÊNCIAS 
 
 
Pesquisado por: 
José Henrique, Rafael Chang, Sandokan Costa, Érico Melo, Heyder Cabral, 
Talita Oliveira, Gustavo Oliveira, Eduardo Ditzel, Luis Fernando Tupinambá, 
Marcelo Gomes, Jaime Menezes e Luiz Felipe Tupinambá 
 
1) A fratura da cavidade glenóide que envolve seu terço superior e inclui o 
processo coracóide é classificada segundo IDEBERG como tipo: 
 
 C) III 
 
Fonte: Rockwood and Green’s fractures in Adults 7th ed. 1155 pg. 
________________________________________________________________ 
2) A Leucomalácia periventricular é a lesão característica da: 
 
 A) Diplegia 
 
Fonte: Lovell and Winter’s Pediatric Orthopaedics 6th ed. 554 pg. 
 
 
_________________________________________________________________ 
3) A artropatia neuropática do ombro está relacionada a: 
 
 C) Siringomielia cervical 
 
Fonte: Canale & Beaty: Campbell’s Operative Orthopaedics 11th 1045 pg. 
_________________________________________________________________ 
4) A síndrome medular central ocorre em idosos por mecanismo de: 
 
 B) Hiperextensão, e cursa com tetraparesia que afeta mais os membros 
superiores 
 
Canale & Beaty: Campbell’s Operative Orthopaedics 12th 1572 pg. 
_________________________________________________________________ 
5) Nas lesões irreparáveis do manguito rotador envolvendo os tendões 
supraespinhal e infraespinhal, a transferência muscular quando indicada é 
feita com o: 
 
 B) Grande Dorsal 
 
 
 
Canale & Beaty: Campbell’s Operative Orthopaedics 11th 2619 pg. 
_________________________________________________________________ 
6) Na luxação glenoumeral anterior, a lesão do ligamento glenoumeral 
inferior ocorre na(s): 
 
 C) inserção gleinodal 
 
Canale & Beaty: Campbell’s Operative Orthopaedics 12th 2274 pg. 
_________________________________________________________________ 
7) A dor lombar aguda, após exclusão de sinais de alarme, deve ser tratada 
com: 
 
 D) Respouso no leito por 1 a 3 dias e progressão para programa de 
exercícios físicos 
 
 
 
Canale & Beaty: Campbell’s Operative Orthopaedics 12th 1901 pg. 
_________________________________________________________________ 
8) Na mão torta radial, a estabilização do punho utilizando os flexores 
superficiais deve incluir preferencialmente os tendões dos dedos: 
 
 A) Médio e anular 
 
 
 
 
 
 
 
 
Canale & Beaty: Campbell’s Operative Orthopaedics 12th 3722 pg. 
_________________________________________________________________ 
9- O cisto ósseo simples geralmente é detectado quando o paciente 
apresenta. 
 
B) Fratura patológica 
 
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 Winter’s Pediatric Orthopaedics 6 th ed. Página 526 
 
 
10-A metastase óssea distal ao joelho ou ao cotovelo geralmente é decorrente 
de carcinoma 
 
C) pulmão 
 
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: Campbell’s Operative Orthopaedics 11th ed. Pagina 923 
 
11- O fibroma ossificante localiza-se mais comumente. 
 
A) na tíbia 
 
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 Winter’s Pediatric Orthopaedics 6 th ed. Página 521 
________________________________________________________________ 
12- Durante a puberdade o crescimento do tronco 
 
C) é 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 Winter’s Pediatric Orthopaedics 6 th ed. Página 45 
 
13-A fratura osteocondral do tálus na criança é mais comum na região 
 
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 Bedding
25
 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 โ €œwaferโ €• 
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, 7
th
 ed. Pagina 1026 
 
14-A fratura de estresse no pé da criança 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, 7
th
 ed. Pagina 1054 
 
 
15- A artralgia associada à picada do carrapato geralmente é observada no 
 
b) joelho 
 
Lyme Disease 
Musculoskeletal symptoms include lower extremity cramping and a 
predispositionfor 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 por medicamentos está relacionado 
principalmente ao uso de 
 
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 P-
450 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 
_________________________________________________________________ 
17. A lesão de MONTEGGIA com fratura do terço médio ou proximal da 
ulna e fratura-luxação posterior da cabeça do rádio, é 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: Campbell’s Operative Orthopaedics 12th ed. 2886pg 
_________________________________________________________________ 
18. Na deformidade em botoeira, a imobilização para o tratamento 
conservador deve manter a IFP em extensão 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: Campbell’s Operative Orthopaedics 12th ed. 
3294pg 
________________________________________________________________ 
19. A capsulite adesiva do ombro tem maior incidência 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: Campbell’s Operative Orthopaedics 11th ed. 2625pg 
_________________________________________________________________ 
20. Na lesão do anel pélvico, as artérias do sistema ilíaco interno mais 
relacionadas à hemorragia são a glútea: 
 
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 Green’s fractures in adults 7th ed, p1419 
_________________________________________________________________ 
21. No estágio II da insuficiência do tendão do tibial posterior, classificada 
por JOHNSON e STROM, encontramos no exame físico: 
 
c) compensação para inversão do pé 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: Campbell’s Operative Orthopaedics 12th ed. 3908pg 
 
 
_________________________________________________________________ 
22. Na fratura do antebraço da criança que ocorre por mecanismo indireto, 
os segmentos mais vulneráveis ao trauma no rádio e na ulna são, 
respectivamente: 
 
a) transição médio-distal e diáfise 
 
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 Wilkins’s fractures in children 7th ed p350 
_________________________________________________________________ 
23. Na pseudartrose após osteossíntese intramedular, o exame de imagem 
com maior sensibilidade para o diagnóstico é a: 
 
d) tomografia computadorizada 
 
Não 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 síndrome de REITER caracteriza-se por conjuntivite, uretrite e 
sinovite: 
 
d) assimétrica 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: Campbell’s Operative Orthopaedics 12th ed. 3558pg 
_________________________________________________________________ 
25. Na fratura diafisária do fêmur, a fixação interna com placa pela via 
aberta está mais bem indicada na presença de: 
 
d) fratura ipsilateral do colo do fêmur 
 
Fonte: Rockwood and Green’s fractures in adults 7th ed, p1668 
_________________________________________________________________ 
 
26. A fratura do colo do fêmur mais frequente na criança, segundo a 
classificação 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 Wilkins’s fractures in children 7th ed p772 
_________________________________________________________________ 
27. O granuloma eosinofílico em apresentação isolada é encontrado mais 
frequentemente: 
 
a) no crânio e no fêmur 
 
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 low-
grade 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: Tachdjian’s Pediatric Orthopaedics 4th ed, 227pg 
_________________________________________________________________ 
28. No mecanismo da luxação anterior traumática do quadril, o membro 
inferior está posicionado em rotação: 
d) lateral e abdução 
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: Campbell’s Operative Orthopaedics 11th ed. 3296pg 
_________________________________________________________________ 
29) Na ruptura fechada do tendão calcâneo, o mecanismo de lesão mais 
comum envolve: 
D) Flexão dorsal do pé com o joelho em extensão. 
 “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 12
th
, pg 2321 
 
 
30) Na mielomeningocele, as fraturas ocorrem frequentemente na 
extremidade: 
A) Distal do fêmur 
“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 5
th
. pg e136 (1906 do pdf) 
 
 
31) A Fratura da Clavícula 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 é 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 criança 8
th
. pg 248 
 
 
33) Na avaliação radiográfica do acetábulo, a dissociação entre a linha 
ilioisquiática e gota de lágrima de Kohler sugerem fratura: 
D) Da superfície quadrilátera. 
“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 8
th
. pg. 1900 
 
 
34) A ruptura do tendão do quadríceps é 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 12
th
. pg. 2336-2337. 
 
 
 
 
35) Na rigidez pós-traumática da articulação metacarpofalângica, a 
capsulotomia é contraindicada se o arco de movimento alcançar: 
 
D) 60º 
 
“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 12
th
. pg 3361 (quadro azul) 
 
 
36) Na luxação da aticulação acrômio-clavicular do tipo III de Rockwood, 
existe integridade dos ligamentos coracoclaviculares quando há 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 8
th
. pg. 1585 
 
 
37 - Na confecção da banda de tensão para tratamento da fratura de 
olécrano, a colocação dos fios de KIRSCHNER em posição 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 lefttoo 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 Green’s 
Fractures in Aduldts 8 th ed. 
1218 pg. 
_________________________________________________________________ 
38 - O condrossarcoma primário tem seu pico de incidência na faixa etária 
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: Campbell’s Operative Orthopedics 12th. 914 pg. 
 
 
39) No exame físico da mão, se a articulação interfalângica proximal não 
flexiona passivamente com a metacarpofalângica em extensão e flexiona 
passivamente com a metacarpofalângica em flexão, deve-se pensar em: 
 
C) Retração dos músculos intrínsecos. 
 
“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 12
th
 . pg 3620 
 
40) Na fratura do colo do fêmur do idoso tratada com redução anatômica e 
fixação interna, o fator mais frequentemente relacionado à reoperação é a: 
 
B) falha de osteossíntese 
 
 
 
“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 8
th
. pg. 2047. 
 
41) Na artrogripose, a cirurgia de STEINDLER tem como objetivo a 
correção da deformidade em: 
 
D) extensão 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 5
th
. pg e551 (2320 do pdf) 
 
 
42) A artrose do quadril secundária a OTTO PELVIS ocorre com maior 
frequência 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 síndrome naviculocapitato caracteriza-se por: 
 
C) Fratura do capitato com rotação 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 12
th
. pg 3417 
 
 
44) A paresiados músculos biceps braquial e extensores radiais do carpo, 
assim como a diminuição do reflexo estilo-radial, são características da lesão 
da raiz: 
 
B) C6 
 
 
Fonte: Rockwood adulto 8th. pg 1689 
_______________________________________________________________ 
 
 
 
 
45. Na ruptura do ligamento cruzado anterior, a largura do túnel 
intercondilar é menor 
 
 D) nas mulheres e interfere na ocorrência de lesão 
 
Referência: Campbell ed 11 
 
 
A number of investigators have studied the epidemiology of anterior cruciate 
ligament–deficient 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. 45-
101). 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,shoe-
surface 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 pé torto congênito unilateral tratado pelo método de PONSETI, a 
órtese de DENIS BROWNE no pé normal deve ser utilizada com rotação 
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 diáfise da tíbia, a lesão neurológica mais comum após 
osteossíntese intramedular é a do nervo 
 
D) fibular comum 
 
 
 
A lesão neurológica mais comum após a osteossítese intramedular de uma 
fratura tibial é a lesão do nervo fibular. Koval et al. Documentaram uma 
prevalência das lesões neurológicas de aproximadamente 30% em uma revisão 
retrospectiva de 60 pacientes tratados com uma haste intramedular com 
fresagem, mas afirmaram que, na maioria do casos, eram pequenas neuropraxias 
sensitivas; 89% dessas lesões foram temporárias e ficaram curadas em 3 a 6 
meses. No entanto, 2 pacientes em sua série continuaram a exibir deficiência 
nervosa um ano depois do procedimento (nível de evidência 4). 
 
Fonte:Rockwood 7 ed pag. 1903 
_________________________________________________________________ 
48. A ruptura da banda sargital do capuz extensor dos dedos da mão ocorre 
mais comumente do lado 
 
B) ulnar do dedo médio 
 
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 luxação recidivante da patela é 
 
D) a competência 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 parts—the 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 doença de LEGG-CALVÉ-PERTHES, a subluxação e o achatamento 
da cabeça femoral ocorrem na fase de 
 
B) fragmentação 
 
 
 
Waldenström'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. Waldenström 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 beonly 
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, 
often mild and intermittent 
Increased density of femoral 
head, with/without subchondral 
fracture 
Fragmentati
on stage 
Pain and limp may worsen; 
may lose range of motion 
Head shows fragmentation, may 
lateralize and flatten 
Reossificati
on stage 
Limp and pain gradually 
resolve, range of motion 
improves 
Femoral head gradually 
reossifies; flattening of head may 
improve 
Healed 
stage 
Occasional limp; occasional 
locking, popping 
May develop osteochondrotic 
lesion 
 
 
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 calcâneo tratada pela via lateral estendida, a principal 
fonte vascular do retalho fasciocutâneo é a artéria 
 
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, Fernandez
64
 first described the extensile posterolateral approach (Fig. 59-
23A). 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 Gould
82
 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
 Borelli
21
 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 arteries—the lateral calcaneal, 
the lateral malleolar, and the lateral tarsal artery—were 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-extensão do cotovelo no plano lateral encontra-se 
 
A) no centro da tróclea 
 
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 transverseaxis 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 displásico dos tipos 3 e 4 de Crowe, a 
principal complicaçãoo neurológica é a lesão do nervo 
 
 D) Isquiático 
 
 
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 lesão de Mannerfelt é relacionada a ruptura do 
tendão 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 lesões musculares são mais comuns em músculos: 
 
 D) biarticulares e naqueles com predominância 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 AFIRMAÇÃO EXISTE NO CAMPBELL 11ª ed E FOI OMITIDA NO 
CAMPBELL 12ª ed 
Fonte: Campbell 11 th ed. 2747 
_________________________________________________________________ 
56) Uma fratura AO 43A3 com exposição de 3cm e lesão isolada da artéria 
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 subtrocantérica de fêmur, o implante 
mais recomendado é: 
 
B) haste intramedular anterógrada 
 
Fonte: Jupter J:. Skeletal Trauma 4 th ed. 2021 
_________________________________________________________________ 
58) Na osteogênese imperfeita classificada segundo SILENCE, a fragilidade 
óssea é mais grave no tipo: 
 
B) II 
 
 
 
 
Fonte: Tachdjian 4th. Pg 1947 
_________________________________________________________________ 
59) Na fratura isolada da cabeça do rádio classificada por MASON como 
tipo II, é indicação absoluta de tratamento cirúrgico: 
 
A) Restrição da rotação do antebraço 
 
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 hematogênica aguda do terço proximal do fêmur 
apresenta maior possibilidade de evolução para osteonecrose da epífise na 
faixa etária 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 lesão meniscal do joelho é realizado: 
B) de flexão para extensão, em decúbito 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: Campbell´s Operative Orthopedics 11
th
 ed. 2424 pg 
 
62 – No cordoma sacrococcígeo, o diagnóstico radiográfico é dificultado 
pela: 
A) presença de gás 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 bebetter 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: Campbell´s Operative Orthopedics 11
th
 ed. 914 pg 
 
63 – Na artroplastia total de joelho, o corte posterior dos condilos femorais 
deve ser feito com: 
C) 3° de rotação 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: Campbell´s Operative Orthopedics 11
th
 ed. 265 pg 
 
 
64 – No ombro, o estabilizador primário da transição ântrero-posterior da 
cabeça do úmero é: 
 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 Green´s fractures in Adults 7
th
 ed. 1165-66 
 
65 – Na fratura do processo odontóide, a fixação com parafuso é 
contraindicada se houver: 
D) traço de fratura de ântero-inferior para póstero-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 Green´s fractures in Adults 7
th
 ed. 1350 
 
66 – Na incidência radiográfica em perfil da escápula, a posição da cabeça 
do úmero em relação ao centro do Y é: 
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 Green´s fractures in Adults 7
th
 ed. 991 
 
 
67 – Na displasia do desenvolvimento do quadril diagnosticada tardiamente, 
o obstáculo intra-articular mais significativo para a redução é: 
A) a constrição da cápsula 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 andenlarged. 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 Winter´s Pediatric Orthopaedics 7
th
 ed. 991pg 
 
68 – A deformidade em rotação interna dos ossos da perna é associada ao 
pé: 
 B) torto congênito. 
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: Tachdjian´s Pediatric Orthopaedics 11
th
 ed 1103pg 
 
 
69) Na fratura Toracolombar avaliada segundo a classificação de 
distribuição de carga (Load Sharing Classification), a via anterior é indicada 
quando o somatório de pontos é: 
 
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 
et al.
105 
separated these injuries into six discrete groups: wedge-compression, 
stable and unstable burst, Chance, flexion–distraction, 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 
compression) was most suitable for each fracture. McCormack et al.
106 
devised 
the “load-sharing classification,” which uses a grading system to assess 
vertebral body comminution, displacement of bony frag- ments, and post-
traumatic 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 8ª Edição, 1768 p. 
_________________________________________________________________ 
70) A complicação nervosa mais frequente observada na lesão de Monteggia 
é a lesão do: 
 D) Interósseo Posterior 
“… no entanto, o nervo Interósseo Posterior é, de longe, o mais comumente 
lesionando, especialmente em associação com uma fratura-luxação de 
Monteggia” 
Fonte: RW 7ª Edição, 900 p. 
_________________________________________________________________ 
71) Na infecção vertebral, a principal via de disseminação é: 
 A) Hematogênica 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 12ª Edição, 1967 p. 
_________________________________________________________________ 
72) Na fratura diafisária proximal do radio, o desvio do fragment superior 
ocorre pela ação dos músculos: 
 D) Supinador e Bíceps Braquial 
“ Em fraturas da parte superior do radio, abaixo da inserção do supinador e 
acima da da inserção do pronador redondo, dois músculos robustos (biceps e 
supinador) exercem uma força sem obstáculo que promove a supinação do 
fragmento radial.” 
Fonte: RW, 7ª Edição, 887 p. 
_________________________________________________________________ 
73) A Doença 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 12ª Edição, 3625 p. 
_________________________________________________________________ 
74) Na fratura da extremidade proximal do úmero, a complicação mais 
comum é: 
 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 12ª Edição, 2851 p. 
 
 
_________________________________________________________________ 
 
75) O padrão mais simples de fratura-luxação do cotovelo é: 
 B) Luxação Posterior com Fratura da Cabeça do Rádio 
 “ O padrão mais simples de fratura-luxação do cotovelo é a luxação 
posterior do cotovelo com fratura da cabeça do radio” 
Fonte: RW 7ª Edição, 929 p. 
_________________________________________________________________ 
 
76) A principal complicação da artroplastia semiconstrita do cotovelo é: 
 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 12ª Edição, 575 p. 
_________________________________________________________________ 
 
 
77 – Na escoliose idiopatica do adolescente, o risco de progress da 
deformidade entes da maturidade esquelética está 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 
scoliosis—that is, an equal prevalence between the sexes for small curves 
(<10 degrees), with increasing female prevalence for larger and progressive 
curves—has 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,96,455,534and 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 5
th
 Ed. Página 206 
 
 
 
78 – Na Tibia vara de Blount o Angulo de LEVINE-DRENNAN 
 
A) Pouco confiável quando usado isoladamente 
 
Levine and Drennan measured the tibial metaphyseal–diaphyseal 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 5
th
 Ed. Página 714-16 
 
 
 
79- Na fratura supracondiliana do úmero em extensão, o desvio mais comum 
do fragmento distal é 
 
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. Página 583 
 
 
 
 
 
 
 
80- A fusão do arco posterior do atlas ocorre na faixa etária 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 5
th
 Ed. Página 167 
 
 
 
81 – O corte transversal do radio nas suas porções proximal, média e distal é 
respectivamente: 
 
C- Cilíndrico, 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 5
th
 Ed. Página 1333 
 
 
 
82 – Na síndrome do túnel radial, a compressão do nervo interósseo 
posterior ocorre 
 
D) Na origem do músculo 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 metáfise proximal da tibia em crianças, a complicação 
tardia associada a interposição da pata de ganso é 
 
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 Página 440 
Fonte utilizada para a resposta: Fonte: Rockwood and Wilkin`s fractures in 
Children 8th ed. Página 1141 
 
 
84 – A vascularização da cabeça do femur depende predominantemente dos 
vasos capsulares localizados nas regiões 
 
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