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? |
|
| 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? |
|
| 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 |
|
| 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? |
|
| 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 |
|
| 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? |
|
| 26.Non-absorbable natural sutures? |
|
| 27.Non-absorbable synthetic sutures? |
|
| 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 |
space
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? |
|
| 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? |
|
| 9.What anatomy should you be able to identify in a joint scope? |
|
| 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? |
|
| 13.Complications? |
|
| 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 |
PrePodiatryStudy 