Surgery

Basics

1.Vassal Principle?	Adjacent fractures generally improve alignment after reduction of the initial fracture because soft tissue structures are returned to their normal position through traction.
2.Kirchner wires sizes?	-0.028″ -0.035″ -0.045″ -0.062″
3.Steinman Pins?	5/64″-3/26″
4.What are the two major types of nonunions?	1. Hypertrophic: elephant foot, horse hoof, oligotrophic 2. Atrophic: torsion wedge, comminuted, defect, atrophic
5.How do you treat each non union type?	1. Hypertrophic nonunion: you have to immobilize these, and you can choose to use electrical bone stimulation as a primary form of therapy 2. Atrophic nonunion: you have to use an autogenous graft prior to using electrical bone stimulation. You can’t go from an avascular nonunion and try to use bone stimulation as a primary form of treatment.
6.Antibiotics that are added to saline solution when using a pulse lavage?	Polymyxin and bacitracin
7.What type of cartilage is regrown after subchondral drilling?	Fibrocartilage
8. What is the maximum amount of displacement without the need for ORIF?	2mm
9.Surgical Layers of Dissection	1.Skin 2. Superficial Fascia -First Dissection Interval containing superficial neurovascular structures 3. Deep Fascia -Second Dissection Interval containing muscular and deep neurovascular structures 4. Periosteum 5. Bone
10.Esmarch bandage?	Blue band used before activating tourniquet. Uses 200-500mmHg range of pressure
11.Calf Tourniquets time and pressure?	-Location: Supramalleolar, Proximal calf. -Pressure: Approximately 250mmHg -Time: 90-120 minutes
12.Thigh Tourniquets?	-Location: Proximal thigh. -Pressure: Up to 350 mmHg. -Up to 120 minutes
13.What is a ganglion cyst in the foot?	A sac filled with fluid that originates from a tendon sheath or joint capsule. The word “ganglion” means “knot”
14.Reasons for severe intractable pain post-op?	Sutures too tight, constrictive dressings, hematoma, ischemia
15.Post surgery 1 week with redness, pain, in leg, etc, fever. What is likely cause of fever?	DVT vs reinfection of surgical site
16.When do you order Chest xray?	>40 yo, smoker, lung or heart problems
17.When do you order EKG?	>40 yo, history of heart problems
18.When can you do foot surgery after patient had heart attack or CABG?	6 months
19.Reasons to Re-Admit a post-op patient?	1. Uncontrollable pain 2. Uncontrollable nausea 3. Medical monitoring is necessary(sepsis) 4. Dizziness, weakness, cannot ambulate
20.Nerves in a Mayo block?	1. Saphenous n 2. Deep peroneal n 3. Medial dorsal cutaneous n 4. Medial plantar n
21.Nerves in an ankle block?	1. Tibial n 2. Saphenous n 3. Medial dorsal cutaneous n 4. Intermediate dorsal cutaneous n 5. Deep peroneal n 6. Sural n
22. Nerves blocked in popliteal block?	Popliteal nerve but not the saphenous N.
23. Nerves blocked in mini-Mayo block (5th digit)?
24.Nerves blocked in 1st digital block?	1st dorsal digital proper N, 2nd dorsal digital proper N. 1st plantar digital proper N, 2nd plantar digital proper N.
25.A patient that has undergone surgery for 3 hours with an ankle tourniquet complains of numbness, what is the most likely diagnosis? A.Neurotemesis B.neuropraxia C.axonotmesis	Answer: B.neuropraxia

(AO) Technique

1.Who first wrote on AO?	1950s by Robert Danis 1963 by Muller, Allgower, and Willenegger
2.What year was the first edition published on AO?	1969 by Swiss AO
3.Principles of AO?	Anatomic Reduction, Stable int. fixation, Atraumatic Technique, Early and pain free ROM
4.Why do we need anatomical reduction?	Restore length, rotation, and axis level
5.Internal fixation?	Rigid compression to prevent movement, thus providing healing
6.Atrumatic technique?	preserve blood supply
7.Early ROM?	prevent cast disease
8.True or False: Bone is weakest during compression?	False. It is strong in compression, weak in tension. The common fractures of transverse and spiral fractures when you bend and add tension to bone.
9.What type of fracture may have butterfly fragments or wedge fragments?	Oblique and spiral fracture from twisting force
10.What are the structures of a screw?	head land shank runout core diameter thread diameter pitch lead tip
11.What is the pitch?	distance between two threads
12.What is a cortical screw?	Has a pitch of 1.25 mm, that way more threads can purchase the cortical bone
13.What is a cancellous screw	Pitch 1. 75 mm, much wider to purchase cancellous bone
14.What is the runout?	distance from shank to the beginning of the thread
15.Name the types of screws	self-tapping vs non cortical vs cancellous lag screw vs non mini vs small vs large
16.Which screw is fully threaded, cortical or cancellous screw?	cortical screws are always fully threaded. Cancellous screws can be either fully or partially threaded.
17.What is a lag screw?	self drilling/tapping screw
18.What are examples of lag screws?	partially threaded screws, malleolar screws, and large cancellous bone screws. None of these screws have threads in the near cortex.
19.At what angle is the screw inserted to the fracture line?	At a perpendicular (90 degrees) to fracture line to get proper compression without shifting/sliding forces when drilling.
20.When should you use a lag screw?	works well for intra-articular fractures, and avulsion fractures.
21.AO screw size and order?	Over, under, counter, measure, tap, screw. Mini frag – 1.5/1.1 2.0/1.5 2.7/2.0 Small frag – 3.5/2.5 4.0/2.5 Standard – 4.5/3.2 6.5/3.2
22.A 2.7mm lag screw fails and you want to put 3.5mm, what do you do?	Predrill with 2.5mm, Overdrill near cortex with 3.5mm

Plates Fixation

1.What are the types of plates?	Neutralization, compression, buttress, anti-glide, bridge, and locking plates
2.What is neutralization plate?	It protects the lag screw from bending and torsion.
3.What is an anti-glide plate?	a neutralization plate placed on the posterior aspect of the fibula
4.What are the two sub types of compression plates?	static compression, and dynamic compression plate
5.What is static compression plate?	tension is applied to the implat and compression is made at the fracture site. Used for transverse or oblique fractures.
6.What is dynamic compression plate?	Compression is made at the fracture site and makes further compression when the bone is loaded. Same principle as tension band wire.
7.What is a buttress plate?	protects bone while preventing bending forces. Used commonly in pilon fractures.
8.What is a bridge plate?
9.What is a locking plate?	A locking screw that merges with a locking plate. Use for osteopenic or shattered bone
10.Types of tubular plates?	-Mini frag set: 1/4 tubular -Small frag set: 1/3 tubular set -Large frag set: 1/2 tubular set
11.What is the point of a plate in a fibular fracture after you put in the interfrag screw?	Neutralization
12.What is stainless steel made of?	-iron -chrome -nickel (patients may be allergic to this) -molybdenum -carbon
13.What part of stainless steel screw can cause allergy?	nickel

Sutures

1.Name the types of sutures	absorbable vs non- mono vs multifilament natural vs synthetic size needle ends (blunt, cutting, tapered)
2.How do you determine suture size?	More 0’s = thinner EX: 4-0 suture (0000) thin,3-0 suture (000) so its thicker
3.Suture that has antibiotic properties?	Vicryl Plus, coated with the abx Triclosan
4.What is the least reactive suture?	Polypropylene (Prolene)
5.What is Vicryl?	Absorbable suture; polyglycolic acid; coated and braided.
6.What is Prolene?	Non-absorbable suture; Polypropelene
7.What is Ethilon?	Nylon suture, non absorbable monofilamet
8.Which sutures generally would not be used in the presence of infection?	Silk
9.Which type of needle point would be selected for use on tendon?	Cutting needle
10.The type of needle point used on soft tissue?	Tapered needle
11.Suture is a polyester fiber suture?	Ethibond, don’t confuse with ethilon!
12.Suture that is absorbable and offers extended wound support ?	Polydioxanone (PDS) takes 180 days to absorb
13.Another name for polyglactin 910 is?	Vicryl
14.Which needle point would be selected for use on skin?	Cutting needle
15.Why would you rather leave a wound open than force a tight approximation?	If too tight it can cause ischemia
16.When would you use a Blunt needle end?	for the liver
17.Provides strength and non-reactivity in tissues where stainless steel cannot be used is?	Polypropelene
18.What is dehiscence?	separation of the wound tissues
19.Polyglycolic Acid	(Dexon) – Synthetic – Absorbable 14 – 21 days – breaks down by hydrolysis – Multifilament
20.Polyglactin 910	(Vicryl) – Synthetic – Absorbable – Multifilament
21.Polydioxanone	(PDS) – Synthetic – Absorbable 10 – 21 days – broken down by hydrolysis – Monofilament
22.Nylon – Polyamide	(Ethilon) – Synthetic – non-absorbable – Multi and Monofilament – minimum of 2 year hold before strength breaks down
23. Polyester	-Synthetic – non-absorbable – Multifilament
24.What is everted skin lines?	when suturing, you want the skin edges to come outwards
25.Absorbable synthetic sutures?	Vicryl (Polyglactin 910) Dexon (Polyglycolic acid) PDS (Polydiaxonone) Maxon (Polyglyconate) Monocril
26.Non-absorbable natural sutures?	silk cotton (weakest of all sutures)
27.Non-absorbable synthetic sutures?	Nylon (Ethilon, Surgilon) Polpropylene (Prolene) Polyester(Ethibond) Fiberwire Stainless Steel
28.Skin sutures are removed at how many days?	10-14 days b/c at this point the tensile strength of the wound equals the tensile strength of the suture

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Arthrosocopy

1.What is arthroscopy?	an endoscope inserted into an articular joint in a minimally invasive fashion.
2.What year did it start?	1919 in Tokyo by Kenji Takagi credited as the first to do arthroscope of a knee. However, recently discovered that the earliest reported was in 1912 by Dr. Severin Nordentoft in Berlin, Germany.
3.What are the advantages?	no open surgery small incisions reduced recovery time less trauma to connective tissue
4.How may incisions are made at minimum?	two (2), one for arthroscope and one for instruments
5.The joint is small, how do you expand it?	In joints you use saline irrigation fluid to distend and make space. In other areas, such as GI, you use gases to distend belly.
6.What are the degrees available for visualization in arthroscopy?	70°, 45°, 30°, and 0°
7.Besides the scope, what other instruments are associated with this surgery instrument set?	Grasps, retrievers , punches, needle drivers, burs
8.What are the three arthroscope visualization techniques?	pistoning (forward & backward) sweping (left to right) rotating (360°)
9.What anatomy should you be able to identify in a joint scope?	bone articular cartilage syovium ligaments (if any) capsule
10.What is an Obturator?	dull insertion rod used with cannula (known as the pencil tip)
11.What is a Trocar?	sharp insertion rod used with cannula
12.Arthoscopy uses in podiatry?	gastroc release ankle joint assesment OCD talar dome plantar fascia release 1st MTPJ inerdigital nerve decompression
13.Complications?	infection blood clot stiffness edema
14.When the force of the fluid is pressing against blood vessels inside the joint is called?	Tamponade effect
15.What type of scope attaches directly to the camera head?	C-mount
16.A Bur is used for what in arthroscopy?	To remove or take down bone
17.What device would you use to run foot pedals wireless?	i switch pedal
18.What portal in ankle arthroscopy is most utilized and the easiest to identify?	anteromedial portal, medial to the tibialis anterior
19.What structures do you need to avoid medially?	-saphenous vein -saphenous nerve -tibialis anterior
20.Where is the incision placed for anterocentral portal?	1.5 to 2.0 cm lateral to DP Artery