Kaiser SF Flashcards
Distance a skin bridge needs to be
7mm
Treatments recommended for Lisfranc, how long screws should be left in after ORIF
3-6 months
What material is used for charcot fixation screws?
titanium – because on MRI it has less of a signal produced
What’s seen on lateral incision for fixing fibula fractures?
Mercedes sign
- lateral shoulder of the talus
- lateral tibia plafond
- medial aspect of the fibula facet
What does it mean if you can see all 3 aspects of mercedes sing?
If you can see all 3, it means that:
- fibula is brought out to length
- fibula is in sagittal plane appropriately
- syndesmosis is stable
Syndesmotic screw placement when confirming placement with a _______ fluoro view
Syndesmotic screw placement when confirming placement with a LATERAL fluoro view
- -
- Central or anterior screw orientation is ok
- Posterior screw orientation/drift is unstable
Perosteum invagination. What fx do you see this? What do you do with it?
- With medial mal tension fractures, the perosteum is pulled inwards (invaginates)
- This needs to be removed and sutured out of the way of the bone apposition, or else there is a risk of it becoming a non-union (Kaiser research study)
What is used for conscious sedation for reducing an extensive ankle fracture ?
Propofol
What’s the Quigley’s maneuver ?
- Can do this by holding big toe, or with stockinette tied to an IV pole
- Knee flexion & leg external rotation, foot supination & adduction for reduction
- Good for reducing SER ankle fractures
- Doesn’t work well if there is a fracture to the medial mal ( there may be overcorrection)
What do you address posterior mal fractures?
- Don’t need to address these during surgery unless they are big and take up 25% of the joint (then they need fixation)
What is the LRINEC score (laboratory risk indicator for necrotizing fasciitis)? When to use it?
- Classification score used by internal medicine/ICU/medicine for communicating to pod about a nec fasc infection.
- Distinguish necrotizing fasciitis vs. severe cellulitis vs. abscess
- On patients with a concerning hx or physical exam (such as pain out of proportion or rapidly progressive cellulitis)
- On a patient with an unconcerning story (can provide reassurance if score is low)
How do you calculate the LRINEC score (laboratory risk indicator for necrotizing fasciitis)? How is it classified?
Calculates a score with:
- C-reactive protein
- WBC count
- Hemoglobin
- Sodium
- Creatinine
- Glucose
Score classifies into 3 groups:
- low (<50% chance of nec fasc)
- moderate (50-75% chance)
- high risk (>75% chance)
What is diagnostic for necrotizing faciitis?
Operative exploration finding of: greyish foul-smelling “dishwater” pus
What is a characteristic drug to give for patients when necrotizing fasciitis is suspected? MOA?
Clindamycin
Anti-ribosomal 50s –> disrupts protein synthesis of bacteria
What bus causes nec fasc?
- Group B strep
- Peptostreptococcus
- Clostridium
