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Examination: Bernese Periacetabular Osteotomy for Hip Dysplasia in Young Adults
APRIL 2002, VOL 75, NO 4
Examination BERNESE PERIACE~ABULAR osmommm FOR HIP DVSPIASIA IN YOUNG ADULTS
arteries.
1.The term dysplasia describes a. internal carotid b. common iliac c. brachial d. vertebral
a. weakening or degeneration of muscle. b. abnormality in performing voluntary muscle movements. c. abnormal development of tissue. d. strong, involuntary, painfd muscle spasms.
8.The acetabulum receives its blood supply from branches of the artery. a. internal iliac b. external iliac c. internal lumbar d. median sacral
2.An association has been shown to exist between developmental dysplasia of the hip (DDH) and the development of pelvic carcinoma. a. true b. false
9.The majority of patients with DDH primarily have an abnormality on the side of the joint. a. femoral b. acetabular c. inguinal d. obturator
3.If left untreated,
of people affected with DDH may suffer from osteoarthritis by age 50. a. 10% to 20% b. 20% to 35% C. 35% to 45% d. 25% to 50%
4.The hip is a ball and socket or a. enarthrosis b. synarthrotic c. amphiarthritic d. hinge
joint.
5.The nerves combine to form the lumbar plexus, which lies in the posterior portion of the psoas muscle. a. first through fifth thoracic b. first through fourth sacral c. first through fifth lumbar d. first through fourth lumbar 6.The femoral nerve is located on the anteromedia1 side of the iliopsoas, muscle and passes under the ligament as it enters the thigh. a. femoral b. iliac c. inguinal d. obturator
10.Risk factors for DDH include all of the following except a. breech presentation birth. b. gender. c. lower limb deformity. d. fetal alcohol syndrome. 11.Physical signs may include all of the following except a. restricted range of motion in the affected hip. b. pelvic obliquity. c. intermittent claudication in the affected leg. d. leg length discrepancy. 1 2 I n a positive Trendelenburg’s test, the iliac crest on the side opposite the defective weight-bearing leg will drop. a. true b. false 13.All of the following are steps of the apprehension test except a. the patient lies on the affected hip.
7.The abdominal aorta divides at the fourth lumbar vertebra into the right and left 752
AORN JOURNAL
APRIL 2002, VOL 75. NO 4
b. the affected leg hangs over the end of the examination table. c. the unaffected hip is flexed and held by the patient. d. the examiner passively rotates the affected hip externally and hyperextends it simultaneously.
redirecting the pressure on the joint. b. increases the containment and coverage of the femoral head. c. optimizes the articular congruency in the joint. d. increases the surface contact area on the weight-bearing surface.
14.Preoperative x-rays of the patient should include
#).Improving congruency and decreasing articular pressure by increasing articular surface contact area can a. markedly lessen the patient’s pain. b. halt destruction of the joint. c. reduce the risk of hemorrhage. d. lessen the chance of recurrence.
a. false profile, bilateral long leg standing, and functional hip radiographs. b. anterioriposterior (AP) view of the pelvis and chest and functional hip radiographs. c. AP of the hip. false profile, and functional hip radiographs. d. false profile, bilateral long leg standing, and functional hip radiographs. 15.Conservative nonsurgical management may include a. weight loss, ultrasonic heat treatments, and using a variety of anti-inflammatory and analgesic medications. b. weight loss, physical therapy for gait correction, and modification of activities. c. use of a cane, ultrasonic heat treatments, and physical therapy for gait correction. d. use of a cane and anti-inflammatory and analgesic medications and modifying activities. 16.A total hip arthroplasty is the best surgical option for young, physically active patients. a. true b. false 17.Patients with DDH are a high risk for developing early osteoarthritis because a. the femoral head of the affected hip necrotizes. b. there is poor blood supply to the articular cartilage in the acetabulum. c. the weight supported by the hip joint is concentrated over a smaller surface area. d. cartilage is scraped off the femoral head as it subluxes over the rim of the acetabulum. 18.The goal of treatment is to a. relieve pain during activities of daily living (ADL). b. increase leg length on the affected side. c. form a neo-acetabulum. d. prevent osteoarthritis. 19.Redirecting the acetabulum is the most acceptable physiological solution for all of the following reasons except it a. increases blood supply to the femoral head by
21.Contraindications for this procedure include a. severe degenerative joint disease or being age 65 or older with severely limited range of motion in the affected hip. b. being age 65 or older with severely limited range of motion in the affected hip or morbidly obese. c. being younger than age 20 with clinical signs of osteoarthritis or morbidly obese. d. degenerative joint disease or having had previous pelvic surgery. =Members from the physical and occupational therapy departments will instruct the patient on a. occupational changes required after surgery and provide tools to assist with ADL. b. wound care and occupational changes required after surgery. c. postoperative wound care and pain management methods. d. postoperative ambulation and provide tools to assist with ADL. =The electromyography technician places wire leads so that the and nerves can be monitored. a. sciaticiinguinal b. trochantericiinternal iliac c. femoraVsciatic d. common iliacifemoral
24. Wire leads are placed below the surgical area so they do not interfere with surgery; however, the leads are connected to cords that must be adhered to the bed with sterile adhesive drapes. a. true b. false =.The patient’s surgical leg is draped free to a. minimize the risk of contamination. 754
AORN JOURNAL
APRIL 2002, VOL 75, NO 4
d. act as a “joystick,” allowing the surgeon to attain the desired correction of the acetabulum.
b. allow for Foley catheter placement, if needed. c. minimize the chance of nosocomial injury. d. allow for mobility during surgery.
31.The surgeon closes the wound over two 10-Fr round drains, one placed and one placed a. in the inguinal canalijust under the subcutaneous fat layer b. deep along the intrapelvic walVjust under the subcutaneous fat layer c. in the inguinal canalideep along the retroperitoneal space d. deep along the intrapelvic wallideep along the retroperitoneal space
=Which of the following interventions apply to the nursing diagnosis “Risk for infection related to length of procedure, and tissue manipulation during the procedure.” a. Helps to minimize length of the intraoperative phase by planning and anticipating care. b. Reports abnormal preoperative blood coagulation values. c. Assesses renal status preoperatively (eg, renal function studies, urinalysis, health history). d. Positions the patient neutrally and anatomically correct and pads pressure points.
=The PACU nurse assesses the patient for all of the following except a. nausea and vomiting. b. changes from the patient’s preoperative baseline color, warmth, and sensation of both lower extremities. c. blood in the urine. d. changes from the patient’s preoperative baseline presenceiquality of bilateral pedal pulses.
=.Which of the following nursing diagnoses is appropriate for the patient undergoing a Bemese periacetabular osteotomy? a. risk for injury due to positioning and intraoperative manipulation of the operative leg b. risk for ineffective breathing patterns c. risk for impaired home maintenance management (eg. indwelling Foley catheter care) d. risk for sleep pattern disturbance
=An x-ray is taken postoperatively to verify that the acetabulum is corrected and the a. acetabular fragment is secured with cortical screws. b. position of the nasogastric tube. c. position of the Schanz screw. d. location of the central IV line.
=The surgeon flexes and adducts the hip and uses to strip the muscle from the a inner aspect of the pelvis. a. curved osteotome b. hemostat c. periosteal elevator d. pelvic osteotomy chisel 29.The surgeon osteotomizes the a. ischium b. ilium c. pubis d. femur
~
3AComplications of the Bemese PA0 procedure include all of the following except a. extension of the osteotomy through the posterior column of the ileum. b. avascular necrosis of the femoral head. c. intra-articular extension of the iliac osteotomy into the acetabulum. d. deep vein thrombosis.
in two steps.
3O.A Schanz screw is placed into the iliac spine to a. permanently secure the acetabular fragment. b. reattach the rectus femoris to the anterior/ superior iliac spine. c. repair the tensor fascia lata origin.
=.Risks include damage to the sciatic, femoral, or obturator nerves and major blood vessel injury. a. true b. false
AORN, Association of perioperative Registered Nurses, is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center‘s (ANCCs) Commission on Accreditation. AORN recognizes this activity as continuing education for registered nurses. This recognition does not imply thal AORN or the ANCCs Commission on Accreditation approves 01 endorses any praduct included in the activity. AORN maintains the following state board of nursing provider numbers: Alabamo ABNPO075, California CEP 13019, and Florida FBN 2296. Check
with your state board of nursing for occeptabiiify of education activity for relicensure. Professional nurses are invited to submit manuscripts for the Home Study Program. Manuscripts or queries should be sent to Editor, AORN Journal, 21 70 S Parker Rd, Suite 300, Denver, CO 80231571 1. As with all manuscripts sent to the Journal, papers submitted for Hame Study Programs should not have been previouslypublished or submifted simultaneously to ony other publication.
756 AORN JOURNAL
APRIL 2002, VOL 75, NO 4
Answer Sheet BERNESE PERIACETABULAR OSTEOTOMY FOR HIP DYSPLASIA IN YOUNG ADULTS
lease fill out the application and answer form on this page and the evaluation form on the back of this page. Tear the page out of the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2 170 S Parker Rd, Suite 300 Denver, CO 8023 1-5711 or fax with credit card information to (303) 750-3212.
ID Number
B
A score of 70% correct is required for credit.
Session Number
Session # 6473 Event # 02080 Contact hours: 2.5 Fee: Members $12.50; Nonmembers $25
B
0000000000 0000000000 0000000000 0000000000
Program offered April 2002. The deadline for this program is April 30,2005. 1. Record your six-digit member identification number in the appropriate section below (see your member card). 2. Completely darken the space that indicates your answer to the examination starting with question one. Use blue or black ink. 3. Record the time required to complete the program
Mark only one answer per question. 1 21 2 @ @ @ @ @ 22@@@@@ 3 @ @ @ @ @ 23@@@@@ 4 @ @ @ @ @ 24@@@@@ 5@@@@@ 25@@@@@
@@@@a
4. Enclose fee if information is mailed. AORN (ID) # Name Address City State RN license # State Phone number (
i
0000000000~ 00000000000 00000000000000000000 0000000000 ~0000000000
Zip
)
Fee enclosed or bill the credit card indicated 0 MC 0Visa 0Am Express 0Discover Card # Expiration date Signature ( f i r crcdit card authorvation)
757 AORN JOURNAL
@@a@@
APRIL 2002, VOL 75. NO 4
Learner Evaluation BERNESE PERIACFTABULAR OSTEOTOMV FOR HIP WSPLASIA IN YOUNG ADULTS
The following evaluation is used to determine the extent to which this Home Study Program met your learning needs. Rate the following items on a scale of 1 to 5. OBJECTIVES
Session Number 0000000000~
0000000000~ 0000000000 0000000000
(Low) (High)
(Low) (High)
To what extent were the following objectives of this Home Study Program achieved? (1) Identify the anatomy pertinent to developmental dysplasia of the hip (DDH) in the young adult. (2) Discuss the preoperative care of the young adult undergoing Bernese periacetabular osteotomy (PAO). (3) Explain the perioperative nursing care of the young adult undergoing Bemese PAO. (4) Describe the surgical steps of the Bemese PA0 procedure. ( 5 ) Discuss the postoperative course of the young adult recovering from Bemese PAO. PURPOSWGOAL
To educate the perioperative nurse about the Bemese PA0 procedure for repair of DDH in the young adult. CONTENT
(6)Did this article increase your knowledge of the subject matter? (7)Was the content clear and organized? (8)Did this article facilitate learning? (9)Were your individual objectives met? ( I 0)How well did the objectives relate to the overall purposeigoal? TEST WESTIONSIANSWERS
( I I ) Were they reflective of the content? (12) Were they easy to understand? (13)Did they address important points? What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
Author names and addresses:
758 AORN JOURNAL
Examination BERNESE PERIACE~ABULAR osmommm FOR HIP DVSPIASIA IN YOUNG ADULTS
arteries.
1.The term dysplasia describes a. internal carotid b. common iliac c. brachial d. vertebral
a. weakening or degeneration of muscle. b. abnormality in performing voluntary muscle movements. c. abnormal development of tissue. d. strong, involuntary, painfd muscle spasms.
8.The acetabulum receives its blood supply from branches of the artery. a. internal iliac b. external iliac c. internal lumbar d. median sacral
2.An association has been shown to exist between developmental dysplasia of the hip (DDH) and the development of pelvic carcinoma. a. true b. false
9.The majority of patients with DDH primarily have an abnormality on the side of the joint. a. femoral b. acetabular c. inguinal d. obturator
3.If left untreated,
of people affected with DDH may suffer from osteoarthritis by age 50. a. 10% to 20% b. 20% to 35% C. 35% to 45% d. 25% to 50%
4.The hip is a ball and socket or a. enarthrosis b. synarthrotic c. amphiarthritic d. hinge
joint.
5.The nerves combine to form the lumbar plexus, which lies in the posterior portion of the psoas muscle. a. first through fifth thoracic b. first through fourth sacral c. first through fifth lumbar d. first through fourth lumbar 6.The femoral nerve is located on the anteromedia1 side of the iliopsoas, muscle and passes under the ligament as it enters the thigh. a. femoral b. iliac c. inguinal d. obturator
10.Risk factors for DDH include all of the following except a. breech presentation birth. b. gender. c. lower limb deformity. d. fetal alcohol syndrome. 11.Physical signs may include all of the following except a. restricted range of motion in the affected hip. b. pelvic obliquity. c. intermittent claudication in the affected leg. d. leg length discrepancy. 1 2 I n a positive Trendelenburg’s test, the iliac crest on the side opposite the defective weight-bearing leg will drop. a. true b. false 13.All of the following are steps of the apprehension test except a. the patient lies on the affected hip.
7.The abdominal aorta divides at the fourth lumbar vertebra into the right and left 752
AORN JOURNAL
APRIL 2002, VOL 75. NO 4
b. the affected leg hangs over the end of the examination table. c. the unaffected hip is flexed and held by the patient. d. the examiner passively rotates the affected hip externally and hyperextends it simultaneously.
redirecting the pressure on the joint. b. increases the containment and coverage of the femoral head. c. optimizes the articular congruency in the joint. d. increases the surface contact area on the weight-bearing surface.
14.Preoperative x-rays of the patient should include
#).Improving congruency and decreasing articular pressure by increasing articular surface contact area can a. markedly lessen the patient’s pain. b. halt destruction of the joint. c. reduce the risk of hemorrhage. d. lessen the chance of recurrence.
a. false profile, bilateral long leg standing, and functional hip radiographs. b. anterioriposterior (AP) view of the pelvis and chest and functional hip radiographs. c. AP of the hip. false profile, and functional hip radiographs. d. false profile, bilateral long leg standing, and functional hip radiographs. 15.Conservative nonsurgical management may include a. weight loss, ultrasonic heat treatments, and using a variety of anti-inflammatory and analgesic medications. b. weight loss, physical therapy for gait correction, and modification of activities. c. use of a cane, ultrasonic heat treatments, and physical therapy for gait correction. d. use of a cane and anti-inflammatory and analgesic medications and modifying activities. 16.A total hip arthroplasty is the best surgical option for young, physically active patients. a. true b. false 17.Patients with DDH are a high risk for developing early osteoarthritis because a. the femoral head of the affected hip necrotizes. b. there is poor blood supply to the articular cartilage in the acetabulum. c. the weight supported by the hip joint is concentrated over a smaller surface area. d. cartilage is scraped off the femoral head as it subluxes over the rim of the acetabulum. 18.The goal of treatment is to a. relieve pain during activities of daily living (ADL). b. increase leg length on the affected side. c. form a neo-acetabulum. d. prevent osteoarthritis. 19.Redirecting the acetabulum is the most acceptable physiological solution for all of the following reasons except it a. increases blood supply to the femoral head by
21.Contraindications for this procedure include a. severe degenerative joint disease or being age 65 or older with severely limited range of motion in the affected hip. b. being age 65 or older with severely limited range of motion in the affected hip or morbidly obese. c. being younger than age 20 with clinical signs of osteoarthritis or morbidly obese. d. degenerative joint disease or having had previous pelvic surgery. =Members from the physical and occupational therapy departments will instruct the patient on a. occupational changes required after surgery and provide tools to assist with ADL. b. wound care and occupational changes required after surgery. c. postoperative wound care and pain management methods. d. postoperative ambulation and provide tools to assist with ADL. =The electromyography technician places wire leads so that the and nerves can be monitored. a. sciaticiinguinal b. trochantericiinternal iliac c. femoraVsciatic d. common iliacifemoral
24. Wire leads are placed below the surgical area so they do not interfere with surgery; however, the leads are connected to cords that must be adhered to the bed with sterile adhesive drapes. a. true b. false =.The patient’s surgical leg is draped free to a. minimize the risk of contamination. 754
AORN JOURNAL
APRIL 2002, VOL 75, NO 4
d. act as a “joystick,” allowing the surgeon to attain the desired correction of the acetabulum.
b. allow for Foley catheter placement, if needed. c. minimize the chance of nosocomial injury. d. allow for mobility during surgery.
31.The surgeon closes the wound over two 10-Fr round drains, one placed and one placed a. in the inguinal canalijust under the subcutaneous fat layer b. deep along the intrapelvic walVjust under the subcutaneous fat layer c. in the inguinal canalideep along the retroperitoneal space d. deep along the intrapelvic wallideep along the retroperitoneal space
=Which of the following interventions apply to the nursing diagnosis “Risk for infection related to length of procedure, and tissue manipulation during the procedure.” a. Helps to minimize length of the intraoperative phase by planning and anticipating care. b. Reports abnormal preoperative blood coagulation values. c. Assesses renal status preoperatively (eg, renal function studies, urinalysis, health history). d. Positions the patient neutrally and anatomically correct and pads pressure points.
=The PACU nurse assesses the patient for all of the following except a. nausea and vomiting. b. changes from the patient’s preoperative baseline color, warmth, and sensation of both lower extremities. c. blood in the urine. d. changes from the patient’s preoperative baseline presenceiquality of bilateral pedal pulses.
=.Which of the following nursing diagnoses is appropriate for the patient undergoing a Bemese periacetabular osteotomy? a. risk for injury due to positioning and intraoperative manipulation of the operative leg b. risk for ineffective breathing patterns c. risk for impaired home maintenance management (eg. indwelling Foley catheter care) d. risk for sleep pattern disturbance
=An x-ray is taken postoperatively to verify that the acetabulum is corrected and the a. acetabular fragment is secured with cortical screws. b. position of the nasogastric tube. c. position of the Schanz screw. d. location of the central IV line.
=The surgeon flexes and adducts the hip and uses to strip the muscle from the a inner aspect of the pelvis. a. curved osteotome b. hemostat c. periosteal elevator d. pelvic osteotomy chisel 29.The surgeon osteotomizes the a. ischium b. ilium c. pubis d. femur
~
3AComplications of the Bemese PA0 procedure include all of the following except a. extension of the osteotomy through the posterior column of the ileum. b. avascular necrosis of the femoral head. c. intra-articular extension of the iliac osteotomy into the acetabulum. d. deep vein thrombosis.
in two steps.
3O.A Schanz screw is placed into the iliac spine to a. permanently secure the acetabular fragment. b. reattach the rectus femoris to the anterior/ superior iliac spine. c. repair the tensor fascia lata origin.
=.Risks include damage to the sciatic, femoral, or obturator nerves and major blood vessel injury. a. true b. false
AORN, Association of perioperative Registered Nurses, is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center‘s (ANCCs) Commission on Accreditation. AORN recognizes this activity as continuing education for registered nurses. This recognition does not imply thal AORN or the ANCCs Commission on Accreditation approves 01 endorses any praduct included in the activity. AORN maintains the following state board of nursing provider numbers: Alabamo ABNPO075, California CEP 13019, and Florida FBN 2296. Check
with your state board of nursing for occeptabiiify of education activity for relicensure. Professional nurses are invited to submit manuscripts for the Home Study Program. Manuscripts or queries should be sent to Editor, AORN Journal, 21 70 S Parker Rd, Suite 300, Denver, CO 80231571 1. As with all manuscripts sent to the Journal, papers submitted for Hame Study Programs should not have been previouslypublished or submifted simultaneously to ony other publication.
756 AORN JOURNAL
APRIL 2002, VOL 75, NO 4
Answer Sheet BERNESE PERIACETABULAR OSTEOTOMY FOR HIP DYSPLASIA IN YOUNG ADULTS
lease fill out the application and answer form on this page and the evaluation form on the back of this page. Tear the page out of the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2 170 S Parker Rd, Suite 300 Denver, CO 8023 1-5711 or fax with credit card information to (303) 750-3212.
ID Number
B
A score of 70% correct is required for credit.
Session Number
Session # 6473 Event # 02080 Contact hours: 2.5 Fee: Members $12.50; Nonmembers $25
B
0000000000 0000000000 0000000000 0000000000
Program offered April 2002. The deadline for this program is April 30,2005. 1. Record your six-digit member identification number in the appropriate section below (see your member card). 2. Completely darken the space that indicates your answer to the examination starting with question one. Use blue or black ink. 3. Record the time required to complete the program
Mark only one answer per question. 1 21 2 @ @ @ @ @ 22@@@@@ 3 @ @ @ @ @ 23@@@@@ 4 @ @ @ @ @ 24@@@@@ 5@@@@@ 25@@@@@
@@@@a
4. Enclose fee if information is mailed. AORN (ID) # Name Address City State RN license # State Phone number (
i
0000000000~ 00000000000 00000000000000000000 0000000000 ~0000000000
Zip
)
Fee enclosed or bill the credit card indicated 0 MC 0Visa 0Am Express 0Discover Card # Expiration date Signature ( f i r crcdit card authorvation)
757 AORN JOURNAL
@@a@@
APRIL 2002, VOL 75. NO 4
Learner Evaluation BERNESE PERIACFTABULAR OSTEOTOMV FOR HIP WSPLASIA IN YOUNG ADULTS
The following evaluation is used to determine the extent to which this Home Study Program met your learning needs. Rate the following items on a scale of 1 to 5. OBJECTIVES
Session Number 0000000000~
0000000000~ 0000000000 0000000000
(Low) (High)
(Low) (High)
To what extent were the following objectives of this Home Study Program achieved? (1) Identify the anatomy pertinent to developmental dysplasia of the hip (DDH) in the young adult. (2) Discuss the preoperative care of the young adult undergoing Bernese periacetabular osteotomy (PAO). (3) Explain the perioperative nursing care of the young adult undergoing Bemese PAO. (4) Describe the surgical steps of the Bemese PA0 procedure. ( 5 ) Discuss the postoperative course of the young adult recovering from Bemese PAO. PURPOSWGOAL
To educate the perioperative nurse about the Bemese PA0 procedure for repair of DDH in the young adult. CONTENT
(6)Did this article increase your knowledge of the subject matter? (7)Was the content clear and organized? (8)Did this article facilitate learning? (9)Were your individual objectives met? ( I 0)How well did the objectives relate to the overall purposeigoal? TEST WESTIONSIANSWERS
( I I ) Were they reflective of the content? (12) Were they easy to understand? (13)Did they address important points? What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
Author names and addresses:
758 AORN JOURNAL