Flashcards in Pot Pourri Deck (69):
What are the 4 AO principles of internal fixation?
1. anatomic reduction
2. stable internal fixation
3. preservation of blood supply
4. early, active, pain-free ROM
Where does the blood supply to the bone cone from?
periosteum- supplies outer 1/3 of cortical bone
endosteal or medullary vessels (nutrient artery)- supply inner 2/3 of cortical bone
which type of healing heals with callus formation?
secondary healing (or indirect healing)
what is primary (or direct) healing?
bypasses callus formation; occurs with absolute stability ; utilizes cutting cones
what are the differences in bone healing between cortical and cancellous bone?
cortical- undergoes secondary healing (w/ callus formation)
cancellous- no significant callus formation due to tremendous angiogenic potential of trabecular bone
What is AO technique- lag screw by technique?
overdrill, underdrill, countersink, measure
Which step of AO technique does lag screw by design take out?
Where is the apex of deformity in metatarsus adductus?
Lisfranc's joint (tarsometatarsal joint)
Describe the levels of deformity in the skewfoot.
transverse plane adduction
frontal plane inversion
What are the stages of Eichenholtz for charcot neuroarthropthy?
stage 0- at risk for Charcot (e.g. neuropathic diabetic w/ acute sprain or fx)
stage 1- development/fragmentation (red, hot swollen foot; xray shows multiple fractures and subluxation)
stage 2- coalescence (absorption of fine debris; sclerosis of bone ends)
stage 3- reconstruction/consolidation (remodeling of bone)
Describe the stages of Brodsky classification.
Type 1 (most common)- Lisfranc's (tarsometatarsal) joint
Type 2- Chopart's/ STJ
Type 3a- ankle
Type 3b- calcaneus
Type 4- multiple regions
Type 5- forefoot
What are the 3 currently FDA approved meds for treating diabetic foot infection?
1. Zyvox (LInezolid)
2. Zosyn (Piperacillin/tazobactam)
3. Invanz (Ertapenem)
Give a verbal description of the types of Achilles rupture repairs.
Kessel- a box
What is Burrow's triangle?
a wedge of skin and subcutaneous fat excised, usually at the end of a closed wound and created by flap transfer or advancement, so that a smooth repair can be obtained.
What is Virchow's triad?
2. endothelial damage
(all are factors predisposing to a thrombus)
trade name for bupivicaine?
Exparel , Marcaine, Sensoricarine
What is Exparel?
is basically a fat-soluble type of lidocaine (liposome injectable suspension)
How are amides cleared? esters?
amides- cleared by the liver
esters- in the blood by cholinesterases
what is the correct order of correction for clubfoot using the Ponsetti casting method?
what are the main causes of graft failure?
*BONUS- how would you prevent these from happening?
fenestration- prevents hematoma/seroma
bolster dressing- helps with graft adhesion and prevents shearing forces
What angles are used to evaluate a Calc fracture? how do they change in a calcaneal fracture?
Bohler's angle (normal 25-40)- decreases w/ a calc fx
Critical angle of gissane (normal- 120-145)- increases w/ a calc fx
What is the max. dose of lidocaine? (w/ epi and w/o)?
w/o epi: 4.5mg/kg or up to 300mg
w/ epi: 7mg/kg or up to 500mg
What is the max. dose of marcaine? (w/ epi and w/o)?
w/o epi: 2.5mg/kg or up to 175 mg
w/ epi: 3.2mg/ kg or up to 225mg
What is a pantalar fusion?
fusion of the tibiotalar, subtalar, talonavicular and calcaneocuboid joints
What is a tibiotalar fusion called?
What is the ankle fusion technique that is indicated in a child to preserve the potential for growth of the distal tibia and fibular physis?
What is the double calcaneal osteotomy?
Evans with a medial calcaneal slide
(indicated for a RF valgus and FF abudction)
What is the order in which the effects of local anesthetics are felt?
1. loss of pain and temp sensation
2. loss of proprioception
3. loss of touch and pressure sensation
4. motor paralysis
What properties are provided by a bone graft?
What does osteoconduction refer to?
bone graft or implant's ability to provide a structural framework on which host cells reconstitute
*is a scaffold that enables ingrowth of vessels, osteoblasts, and stem cells so that union occurs with the host skeleton
What does osteoinduction refer to?
recruitment of stem cells from the host bed into the graft site, where they differentiate into osteoblasts
Describe the phases of bone graft healing.
What is the mechanism of action of colchicine with respect to gout?
produces anti-inflammatory effect by inhibiting leukocyte migration and phagocytosis (via inhibition of microtubule aggregation)
What are the classes of drugs used to treat gout?
xanthine oxidase inhbitiors (Allopurinol &Febuxostat)
uricosuric drugs- promotes excretion of uric acid (Probenecid & Sulfinpyrazone)
What is included in an admission order?
Admission, Diagnosis, Condition, Vitals, Ambulatory status, nursing instructions, diet, Ins/outs/IVs, Labs, Meds, Ancillary consults, Xrays/imaging
What is the cockroft and gault fault?
(measures creatinine clearance)
(140-age in years) x (weight in kg) / (72 x serum creatinine) x0.85 (if female)
What class of drug is Metformin? MOA?
biguanide- it decreases production of glucose in the liver
What class of drug is Glipizide?MOA?
sulfonylurea- inhibits ATP-sensitive K+ channels of beta-cell --> depolarization --> Ca2+ dependent exocytosis of insulin, stimulating insulin release
"pencil-in-cup" deformity is pathognomonic for what disease process?
-also has "sausage toes" and nail pitting/splitting
what derm manifestation is seen in Reiter's syndrome/ reactive arthritis?
keratoderm blennorrhagicum- describes a pustular lesion on the sole of the foot
Compare and contrast OA vs. RA.
RA- symmetric joint space narrowing; affects MPJ and PIPJ (but spares DIPJ)
OA- asymmetric joint space narrowing; affects PIPJ and DIPJ (but spares MPJs)
What are ways to achieve compression when using plates?
What are signs of hypoglycemia?
What are early radiographic signs of osteomyelitis?
(OM takes 2 weeks to show up on xray after there has been 50% loss of bone)
Differentiate between sequestrum, involucrum, and cloaca.
sequestrum- a piece of necrotic bone separated from living bone by granulation tissue
Involucrum- a layer of living bone that has formed around the dead bone
cloaca- a layer of living bone that may form a sinus and drain
What is Brodie's abscess?
a chronic abscess in bone surrounded by dense fibrous tissue and sclerotic bone, most commonly found in the metaphysis
What type of offloading device can be used to offload ulcers located in the posterior
What are some indications for hyperbaric oxygen therapy?
hypoxic ulcers (i.e. ulcers due to diabetes or arterial insufficiency)
chronic refractory osteomyelitis
compromised or failed flaps
soft tissue radionecrosis
how do you evaluate someone to see if they will benefit from HBO?
transcutaneous oxygen monitoring (TCOMs)
if the TCOM reading is
What 4 things are released in a lateral release?
fibular suspensory ligament
deep transverse intermetatarsal ligament
lateral collateral ligament
causes of hallux varus?
staking the head
aggressive medial capsulorraphy
aggessive post-op bandaging
How should you orient your axis guidewire in an Austin if you want to plantarflex the 1st met?
orient the guidewire so that it is facing down
(superior pole is dorsal media)
Where is the watershed region for the Achilles tendon? What is the significance of this?
2-6cm proximal to the insertion on the calcaneus
*site of AT ruptures
What is the signifiance of repairing the paratenon when performing Achilles tendon repairs?
paratenon permits gliding motion of the tendon as well as provides the VASCULAR supply to the tendon
*it is important to tag the paratenon during sx so that you can repair it
Eccentric training for posterior muscle group is best shown to relieve what type of retrocalcaneal pathology?
Achilles tendinosis (mid-substance)
what nerve is not blocked in a popliteal block?
saphenous n. (becomes it comes from a branch of the femoral n. that doesn't pass thru the popliteal fossa)
What is Engle's angle?
quick estimation of met adductus angle
(normal is 18 deg)
Engle's angle overestimates the MAA by 3-4 deg
What is the true IMA if a patient has met adductus?
true IMA= (MAA- 15) + IMA
What are the 3 FDA-approved antibiotics for treating diabetic foot infections?
(the 3 Z's)
Zosyn (piperacillin/ tazobactam)
What abx are hepatically cleared?
What are the gas-producing bacterium?
bacteroides, E. coli, Clostridium, Staph, Strep, Streptopeptococcus, Serratia, Klebsiella, Peptococcus
what radiographic view could you used to better evaluate a suspected talocalcaneal coalition?
Harris and Beath views
Describe the congenital vertical talus deformity.
(congenital rigid flatfoot) in which there is a fixed dorsal dislocation of the navicular on the head of the talus and a rigid equinus deformity of the hindfoot
what does OATS stand for?
(osteochondral autograft transfer system)
-this procedure is adapated from knee procedures
-The goal is to replace damaged cartilage and subchondralbone with an autologous graft that has similar biological and mechanical properties to the native hyaline articular cartilage
what size OCD lesion is the upper limit for microfracture repair/stimulation of fibrocartilage formation?
15mm (cited by Choi)
what is coonrad bugg trap?
interpositionof soft tissue (tibialis posterio) in severe ankle fx
what is a spontaneous AVN of the navicular in adults called?
(in children, it is called Kohler's)
Ganglion cysts can often be misdiagnosed for what concerning thing?