8. Surgery Flashcards
1
Q
indications for surgical prophylaxis antibiotics
A
- Implants (joint or internal fixation)
- Prolonged surgery (>2 h)
- Trauma surgery
- Revisional surgery
- Immunocompromised patient
- Extensive dissection required
- Intra-operative contamination
- Endocarditis (SBE)
2
Q
MC used antibiotics for surgical prophylaxis
A
- Ancef
- Clindamycin if PCN allergy
- Vancomycin if concerned about MRSA
3
Q
pre-op orders needed for in-house patient
A
- NPO after midnight, except AM meds with sips of water
- Hold all AM hypoglycemics and cover with SSI (if patient with DM)
- Accu-Check on call to OR (if patient with DM)
- Begin ½NSS @ 60 mL/h at 0600 (D5W½NSS if patient with DM)
- Labs – CBC with diff, PT/PTT/INR, BMP
- Chest X-ray, EKG (if necessary)
- Consult medicine for medical clearance (if not already done)
- Anesthesia to see patient (if necessary)
4
Q
indications for pre-op chest x-ray?
A
- >40 years of age
- smoker
- any history of cardiac or pulmonary disease
5
Q
indications for pre-op EKG?
A
- >40 years of age
- any history of cardiac disease
6
Q
MC timeframe for post-op myocardial infarction
A
Day 3
7
Q
how long should elective surgery be DELAYED following an MI or CABG
A
6 months
8
Q
how to calculate daily fluid input requirements?
A
- First 10 kg x 100 = 1000 mL/day
- Second 10 kg x 50 = 500 mL/day
- Remaining kg x 20 = ___ mL/day
- (e.g. 70 kg patient requires 1000 + 500 + 1000 = 2500 mL/day)
9
Q
how to calculate IV fluid input rate
A
- “421 Rule” calculates IV mL/h
- First 10 kg x 4 = 40 mL/h
- Second10 kg x 20 = 20 mL/h
- Remaining kg x 1 = ___ mL/h
- (e.g. 70 kg patient requires 40 + 20 + 50 = 110 mL/h)
10
Q
what other factors should be considered prior to surgery
A
- Is the patient on any insulin, anticoagulants, steroids, or anything else that might put them at risk
- *Note: any non-routine orders should be cleared with patient’s primary service
11
Q
perioperative management for patients with diabetes
A
- NPO after midnight
- Start D5W½NSS in AM
- Accu-Check
- If insulin-controlled, hold regular insulin, give ½ NPH dose, and cover with sliding scale insulin (SSI)
- If oral-controlled, hold oral meds and cover with SSI
- If diet-controlled, cover with SSI
12
Q
what should be obtained prior to surgery on a patient with:
rheumatoid arthritis
A
Cervical spine x-ray
Why? – Cervical joint destruction in rheumatoid arthritis may lead to vertebral instability. The incidence of cervical instability is 5–7% –> Sxs range from initial neck pain radiating to the occiput to painless sensory loss in the extremities and a slowly progressive quadraperesis. Sudden death may also occur.
13
Q
effects of long-term, high-dose course of steroids
A
Long-term therapy suppresses adrenal function
- Risk of poor or delayed wound healing. Decreased inflammatory process.
- Risk of infection. Low WBC may mask infection.
14
Q
periop management for patients on long-term, high-dose steroids
A
- Peri-op IV steroid supplementation
- Hydrocortisone 100 mg IV given the night before surgery, immediately prior to surgery, and then
- q8h until postoperative stress relieved
15
Q
periop management for patients at risk for gout
A
- Begin colchicine 0.6 mg PO daily 3-5 days pre-op
- and continue 1 week post-op
16
Q
periop management for patients with hypertension
A
- If the patient has been on long-term diuretics (e.g. HCTZ, Lasix), check for hypokalemia
- Avoid fluids high in sodium; may use ½NSS at low rate
17
Q
when to discontinue med prior to surgery:
Aspirin
A
7 days preop
due to irreversible binding to platelets
18
Q
when to discontinue med prior to surgery:
NSAIDs
A
3 days preop
due to reversible binding to platelets
19
Q
when to discontinue med prior to surgery:
Heparin
A
8 hours preop
(monitor partial thromboplastin time (PTT)
20
Q
when to discontinue med prior to surgery:
Coumadin
A
3-4 days preop
(monitor PT/INR)
*prothrombin time, international normalized ratio
21
Q
INR for elective surgeries should be:
A
< 1.4
22
Q
what should be done if INR is > 1.4?
A
- If necessary, transfuse Fresh Frozen Plasma (FFP)
- One unit of FFP will decrease INR by approximately 0.2
- Vitamin K can be given but is slow-acting
23
Q
when should a patient with an INR > 1.4 be allowed to proceed with surgery?
A
- If the risk of not doing surgery outweighs the risk of excessive bleeding (i.e. if it is an emergency surgery and you have anesthesia’s approval)
- If the patient has PVD and the surgery is a simple debridement or amputation.
- Note: if the patient has PVD, make sure you have Vascular Surgery’s approval for surgery.
- In this case, it is acceptable for the patient to bleed a little extra.
24
Q
if patient w/ a high INR undergoes surgery, what labs should be carefully monitored?
A
Hgb and Hct
hemoglobin and hematocrit
25
RBC transfusion indications
* If **Hgb \<8 or Hct\<24**, consider transfusing 1-2 units PRBC
* **One unit of PRBC** will increase Hct by approximately **3 percentage points**
26
if patient is **thrombocytopenic**, what can be done
* Order a **six-pack of platelets**, which is a concentration of **six pooled platelet units**, and consult hematology
27
how are relaxed skin tension lines (RSTL) oriented
**perpendicular** to the long axis of the leg and foot
\*also called Langer lines, Cleavage lines, Wrinkle lines and Skin tension lines
*Source: https://musculoskeletalkey.com/plastic-and-reconstructive-surgery/*
28
should a skin incision typically be made parallel or perpendicular to the RSTL?
**parallel incisions will remain approximated and heal better,**
while perpendicular incisions may gap apart due to _increased transverse forces_
29
define: **anti-tension line**
S-shaped or zig-zagged incision when exposure needed is not parallel to RSTL
30
what should the **ratio of length to width** be to close a lesion with _minimal tension_
3:1 length:width
31
how much lengthening can be achieved with a **60o Z-plasty**
**75% lengthening**
* can be achieved with a 60% Z-plasty*
* source: https://www.aafp.org/afp/2003/0601/p2329.html*
32
how should the **Z-plasty incisions be oriented** to _correct a skin contracture_
The **central arm** of the "Z" should be **parallel to the contracture**
Notes: The scar is excised, and a z-plasty is created with the lateral arms being the same length as the central wound. The lateral arms are drawn 60 degrees to the original central wound. The flaps are transposed, lengthening the direction of the original central line. The new central arm aligns with the flexor crease. The added length of skin across the crease prevents reformation of a contracted scar.
*source: https://www.aafp.org/afp/2003/0601/p2329.html*
33
how should the skin incision be oriented to correct
a **5th digit adductovarus rotation**
**Distal medial** to **proximal lateral**
34
order of **wound graft closure**
1. Direct closure
2. Graft
3. Local flap
4. Distant flap
35
stages of skin graft **healing**
1. Plasmatic
2. Inosculation of blood vessels
3. Re-organization
4. Re-innervation
36
what are **Blair** and **Humby knives**?
Knives for harvesting skin grafts
37
MC device for **harvesting skin grafts**
dermatome
*\*used with a mesher*
38
MC complication: **skin grafts**
**\*seroma**, hematome
39
how to prevent seroma/hematoma during skin grafting
mesh or pie-crust graft and apply compressive dressing
40
**advantages** of meshing skin grafts
* **donor site heals spontaneously**
* **expands tissue - *smaller graft can cover larger site***
* *allows drainage of hematoma/seroma through the graft*
* *can drape extremely well around irregular surfaces*
* *increases surface area for re-epithelialization*
41
**disadvantages** of meshing skin grafts
* * graft is very **fragile/delicate** and easily torn
* **contraction** of graft during healing
* **inferior cosmetic** appearance after healing
* *may appear abnormally pigmented*
* heals by **secondary intention**
42
can you mesh a full-thickness skin graft?
NO,
meshing is only for partial thickness skin grafts
43
**advantages** of _full-thickness_ skin graft
* Minimal contraction of graft
* Better appearance
44
**disadvantages** of _full-thickness_ skin graft
* More difficult to take
* Must close donor site
45
**advantages** of using a _muscle flap_
it brings immediate **increased blood supply** to donor site
46
AO principles of internal fixation (2002)
1. Anatomic articular **reduction**, adequate shaft reduction
2. Stable/biologic **fixation**
3. **Preservation** of blood supply
4. **Early ROM**
47
steps to inserting a **fully threaded screw**
1. Overdrill near cortex
2. Underdrill through far cortex
3. Countersink
4. Measure
5. Tap
6. Screw
48
how much of a screw should pass the far cortex
1.5 threads
## Footnote
*(one and one-half)*
49
purpose of tapping a screw
creates a path for the screw heads
* Technique: 2 forward, 1 back
* Cuts the thread pattern of the screw --\> to RELEASE BONE DEBRIS
* Always the same size as the thread diameter.
50
purpose of countersinking a screw
Crozer:
* **prevents stress risers and soft tissue irritation**
* **provides even compression from screw head (land)**
Surg Skills:
* Increases the surface contact area
* makes the screw head less prominent
51
describe mini fragment sets
* Screw sizes of **1.5, 2.0, 2.7**
* all **fully threaded, cortical** screws
52
screwdriver handle is made of:
pressed linen
53
differences between cortical and cancellous screws
* Cortical has **smaller pitch**
* Cortical has **smaller rake angle**
* Cortical has **smaller difference between thread diameter and core diameter**
54
define: **malleolar screw**
* function: for **fixation of medial malleolus**
* characteristics
* **partially threaded**
* **same thread profile and pitch as cortical screw**
* **trephine self-cutting tip**
* *allows insertion w/o tapping, and in osteoporotic bone sometimes even without predrilling the cancellous bone*
* *however, designed as lag screw for medial mall fx, but **due to large diameter & large screw head** --\> smaller cancellous bone screws are used instead*
55
what screw has a **fluted tip**
self-tapping
56
sizes in Synthes modular hand screw system
* 1.0
* 1.3
* 1.5
* 2.0
* 2.4
* 2.7
57
_cannulated screw sizes_ in **Synthes** set?
* 3.0
* 4.0
58
_cannulated screw sizes_ in **Smith & Nephew** set?
* 4.0
* 5.5
* 6.5
* 7.0
59
steps for inserting a 4.0 cannulated screw
1. Insert **1.3 mm guide pin** to far cortex
2. Measure
3. Drill **near** cortex with **4.0 cannulated bit** (optional)
4. Drill **far** cortex with **2.7 cannulated bit** (unnecessary for soft bone)
5. Tap (unnecessary with self tapping screws)
6. Countersink
7. Screw
60
define: **Herbert screw**
* Headless screw – can be inserted through articular cartilage
* \*Also called "compression screws"
* Characteristics:
* Threaded portion proximally and distally and smooth in between.
* Proximal portion has **tighter pitch** for compression.
61
define: **Reese screw**
* Headless – create **compression through arthrodesis.**
* Characteristics:
* **Proximal threads run clockwise**
* Distal threads run counterclockwise. Smooth in between.
62
what are the K wire sizes and widths in millimeters?
63
why is there a question about K-wires in a screw set section in Crozer?
K-wires **can be used for the underdrill** if the situation arises (e.g. underdrill bit is missing or it
fell on the floor)
* The 0.062 can be used for the 1.5 underdrill (for the 2.0 screw)
* The 0.045 can be used for the 1.1 underdrill (for the 1.5 screw)
64
Mnemonic: Young Boys Wear Green
65
sizes of Steinmann pins
Everyone from **5/64 to 12/64**
\*except for 11/64
66
define: **Steinmann pin**
* a metal rod for the internal fixation of fractures by transfixing bone for traction or fixation
* use: most commonly used to repair fractures of the long bones
* characteristics:
* thin metal rod
* medical-grade stainless steel is rust-free that does not cause damage to the bone
67
different types of plate fixation
* compression
* neutralization
* buttress (anti-glide)
* bridge
68
define: **compression plating**
* Provides **axial compression** of fracture
* **Pre-bend** plate
* **Eccentric** drilling of hole adjacent to fracture; remaining holes drilled centrally
* Place plate on **tension side of bone**
69
define: **neutralization plating**
* Protects **against shear, bending, and torsional** forces at the fracture site
* Interfragmental compression obtained by **lag screws**
* All holes drilled **centrally**
70
define: **anti-glide plating**
**Neutralization** plate placed on the **posterior aspect of the fibula**
71
define: **bridge plating**
* Maintains alignment of unstable fracture fragments
* No interfragmental compression
72
should a plate be placed on the TENSION or COMPRESSION side of the fracture?
TENSION side of the fracture
73
is the **tension side** of a metatarsal on the DORSAL or PLANTAR aspect
PLANTAR side of metatarsal is the tension side
74
define: **locking plate**
* Plate in which threaded screws are **secured into threaded plate holes**
* Does not rely on the bone for stability but rather **forms a fixed-angle construct**
* Good for **osteoporotic, comminuted fractures, or revision surgeries**
75
define: **Hooke law**
**strain is proportional to stress** for material under load
76
define: **Young's modulus**
after a load is removed, the material will spring back to its original shape,
the resulting slope represents the stiffness of a material or the Young modulus
77
define: **Keith needle**
straight needle
78
common needle point configurations
* **Taper point** – for soft, easily penetrated tissue (subcutaneous tissue, fascia)
* **Cutting** – cutting edge on inner curve (skin)
* **Reverse cutting** – cutting edge on outer curve for tough, difficult to penetrate tissue
79
what is **orthofix**
**Polyglycolic acid**
| (same as dexon)
80
how long for **orthofix to lose strength/absorb**
* Loses strength in **6-12 weeks**
* **Absorbed in 1-3 years**
81
what is **orthosorb**
PDS
\*polydiaxonone
(PDS=orthosorb)
82
how long before PDS to lose strength/absorb
* Loses strength in **4-6 weeks**
* **Absorbed in 3-6 months**
83
two sutures that are **least reactive** to tissues
* Stainless steel (less reactive)
* Prolene
84
what is **Vicryl**
**Polyglactin 910**
(a copolymer of 90% glycolide and 10% lactide)
85
how is **Vicryl** broken down
**hydrolysis**
**into CO2 and H2O**
*\*broken down by the body over time by processes such as hydrolysis and enzymatic degradation*
86
how long for Vicryl to lose strength/absorb
* Tensile strength
* 75% @ 2 weeks
* **50% @ 3 weeks**
* 25% @ 4 weeks
* Absorbed completely in **10 weeks**
87
can you use Vicryl with an infection
**Avoid it if possible**, since vicryl is too reactive
88
who first described arthroscopy
Takagi
* *Professor Kenji Takagi (1888–1963) was a Japanese orthopedic surgeon, noted for being the first to carry out a successful arthroscopy of the knee; performed first cadaver operation in 1918*
89
first podiatrists to describe podiatric use for arthroscopy
Heller & Vogler (1982)
* described ankle joint arthroscopy*
* Source: Heller AJ, Vogler HW: Ankle Joint Arthroscopy. J Foot Surg 21: 23-29. 1982*
90
different scope techniques
* **Scanning** – side to side, up and down
* **Pistoning** – in and out
* **Rotation** – 360°
91
ankle scope indications
* Synovitis
* Osteochondral lesion/fracture
* Soft tissue impingement
* Osteophytes
* Loose bodies
92
arthroscopy: other uses
* Endoscopic plantar fasciotomy (EPF) or endoscopic gastroc recession
* Ankle fusion
* Arthroscopy of STJ or 1st MPJ
93
MC complication following EPF
## Footnote
*(endoscopic plantar fasciotomy)*
Lateral column instability → calcaneal-cuboid joint pain
94
MC indication for **Lapidus**
hypermobile first ray
*\*Lapidus fuses the 1st met-med*ial cuneiform joint
95
order of the lateral release for a McBride
1. extensor hood
2. ADH tendon release
3. fibular sesamoid ligament
4. lateral collateral ligament
5. flexor hallucis brevis
6. fibular sesamoid excision (if performing)
96
what is the difference between the:
**Vogler, Kalish,** and **Youngswick**
* **Vogler**: offset V (apex at metaphyseal-diaphyseal joint)
* **Kalish**: long-arm Austin with angles of approximately 55o for screw fixation
* **Youngswick**: Austin with a slice taken dorsally to allow decompression and plantar flexion
97
procedures correcting PASA
| (proximal articular surface angle)
* Reverdin
* Peabody
* Biangular austin
* DRATO
* Offset V w/ rotation
98
procedure correcting PASA
| (proximal articular surface angle)
proximal Akin
99
complications: **Keller**
## Footnote
*\*resection arthroplasty of base of proximal phalanx at 1st MPJ*
* diminished propulsion of digit
* loss of hallux purchase
* stress fracture of 2nd metatarsal
100
the capital fragment falls on the floor,
what do you do?
1. Rinse with saline
2. **Bacitracin soak for 15 minutes**
3. Rinse with saline
4. **Bacitracin soak for 15 minutes**
5. Rinse with saline
6. Document and inform patient
101
causes of **white toe** post-operatively
* arterial in nature, usually acute
* signs:
* pain, pale, paresthesia, pulselessness
102
treatments: **white toe**
* D/C ice and elevation
* loosen bandages
* place foot in dependent position
* rotate k-wire
* apply warm compresses proximally (e.g. under popliteal area)
* apply nitroglycerine paste proximally
* local nerve block proximally
* avoid nicotine
* consult vascular surgery
103
causes: **blue toe**
* **poor arterial inflow** - toe is cold and doesn't blanch with pressure
* **poor venous outflow** - toe is warm and will blanch with pressure
104
tx for **arterial insufficiency _blue_ toe**
treat like white toe
* D/C ice and elevation
* loosen bandages
* place foot in dependent position
* rotate k-wire
* apply warm compresses proximally
* apply nitroglycerine paste proximally
* local nerve block proximally
* avoid nicotine **and caffeine**
* **thermostat controlled heat lamp, do not exceed 90o**
* **vasodilators**
* consult vascular surgery
105
tx for **sluggish venous outflow _blue_ toe**
* D/C ice (but **continue elevation**)
* loosen bandages
* **avoid dependency**
* **do NOT** attempt to increase vascular perfusion
* consult vascular surgery
106
describe the Keck & Kelly procedure
* use: Haglund deformity + cavus foot + high calcaneal inclination angle (CIA)
* procedure:
1. remove wedge from posterior-superior aspect of calcaneus
2. posterior-superior prominence is moved anteriorly
107
treatments for equinus
* stretching/ exercises/ PT
* night splints
* gastroc recession
* tendoachilles lengthening
108
gastroc recession procedures for equinus
* baker
* strayer
* vulpius
* mcglamry & fulp
109
tendoachilles lengthening procedures for equinus
* open/closed Z
* hauser
* white
* hoke
* sgarlato
* stewart
110
define: Murphy procedure
Achilles advancement for spastic equinus
111
name procedures for pes **planus**:
**transverse plane** correction
* Evans
* Kidner
* C-C distraction arthrodesis
112
name procedures for pes **planus**:
**sagittal plane** correction
* Cotton
* Young
* Lowman
* Hoke
* Miller
* Cobb
113
name procedures for pes **planus**:
**frontal plane** correction
* Koutsogiannis
* Dwyer
* Chambers
* Gleich
* Baker-Hill
* Lord
114
name procedures for pes cavus:
**_tendon_** procedures
* Jones
* Hibbs
* STATT
* PT
115
name procedures for pes cavus:
**_bone_** procedures
* Dorsiflexory osteotomy of 1st metatarsal
* Cole
* Japas
116
[_Arthroereisis_](https://www.arthrex.com/foot-ankle/arthroereisis):
define
* A surgical procedure to limit joint mobility (i.e. MBA implant in sinus tarsi)
* Typically want **2-4° of STJ eversion** with implant
117
**Valenti** procedure (STJ):
define
* STJ block using a polyethylene plug with screw threads.
* Allows **4-5° of STJ pronation**.
118
first person to describe **triple arthrodesis**
Edwin W. ***Ryerson*** of Chicago in 1923
*(Recall: originally removed blocks of subchondral bone and reapplying as wedges)*
119
order of joint **RESECTION** in a triple arthrodesis
classically:
1. Midtarsal joints (T-N, CCJ)
2. Subtalar joint (T-C)
However, might start with STJ and move to TN, then CC
120
order of joint **FIXATION** in a triple arthrodesis
classically, the reverse of resection:
1. Subtalar joint
2. Midtarsal joints
121
types of fixation for a triple arthrodesis
* 6.5-7.0 mm interfragmental compression screws
* staples
* plates
122
FDA-approved total ankle implants:
**two-component** devices
* Agility
* Eclipse
* INBONE
* Salto Talaris
123
FDA-approved total ankle implants:
**three-component** devices
* **STAR is the only FDA approved 3-component system**
* (Not FDA-approved – Buechal-Pappas, TNK, HINTEGRA)
124
stages of bone healing:
**primary** bone healing
Primary healing – no motion and no callus formation
1. Inflammation
2. Induction
3. Remodeling
125
stages of bone healing:
**secondary** bone healing
Secondary healing – micro-motion with callus formation
1. Inflammation
2. Induction
3. Soft callus
4. Hard callus
5. Remodeling
126
factors that negatively affect bone healing
* \*smoking
* antimetabolite or steroid therapy
* anemia
* osteoporosis
127
name the types of non-unions
hypertrophic
* elephant foot
* horse hoof
* oligotrophic
atrophic
* atrophic
* wedge
* comminuted
* torsion wedge
128
study to distinguish hypertrophic and atrophic non-unions
**Bone scan –**
* +positive for a hypertrophic and
* negative for an atrophic (avascular) non-union
129
pseudoarthrosis:
define
Type of non-union in which **fibrocartilaginous** tissue forms between fracture fragments
130
bone stimulator:
indications
1. Non-union
2. failed fusion
131
delayed union versus non-union
* **Delayed** union: between **4-6 months** after injury **without radiographic progression** of healing or the instability of a fracture upon clinical examination
* **Non-union:** fracture that does not unite **within _9–12 months_**
132
bone stimulators:
contraindications
* pseudoarthrosis
* gap greater than ½ bone diameter
133
avascular necrosis:
stages
1. **Avascular** – loss of blood supply, epiphyseal growth ceases
2. **Revascularization** – infiltration of new blood vessels, new bone deposited on dead bone, flattening or fragmentation of articular surface
3. **Repair and remodeling** – bone deposition replaces bone resorption
4. **Residual deformity** – restoration of epiphysis, sclerosis, deformed articular surface
134
best study to evaluate **avascular necrosis**
MRI –
* **decreased signal intensity** within medullary bone in both T1 and T2 images
135
different types of bone grafts
* **OsteoGENIC** – able to synthesize new bone
* **OsteoINDUCTIVE** – contains factors that induce host tissue to form new bone
* **OsteoCONDUCTIVE** – provides scaffold for host tissue to propagate new bone
136
**osteogenic** bone graft:
examples
Osteogenic – able to synthesize new bone
* Mesenchymal stem cells from autologous bone or bone marrow aspirate
137
**osteo**_inductive_**** bone graft:
examples
**Osteoinductive** – contains factors that induce host tissue to form new bone
* Demineralized bone matrix
* Bone morphogenic protein
* Platelet-derived growth factors
138
**osteo**_conductive_**** bone graft:
examples
Osteoconductive – provides scaffold for host tissue to propagate new bone
* Allografts
* Hydroxyapatite
* Calcium phosphate
* Calcium sulfate
139
what type of bone graft is osteogenic, osteoinductive, AND osteoconductive?
autograft
140
bone graft healing:
stages
1. Vascular ingrowth
2. Osteoblastic proliferation
3. Osteoinduction
4. Osteoconduction
5. Graft remodeling
141
early radiographic finding of bone graft healing
**Initial radiolucency** of the graft due to increased **osteoclastic activity,** which is followed by osteoblasts laying down new bone
142
creeping substitution:
define
Process in which the **host’s cutting cone** (osteoclasts followed by osteoblasts) invade bone graft
143
ASA classification for general anesthesia
American Society of Anesthesiologists classification
1. Class 1 – healthy
2. Class 2 – mild systemic disease
3. Class 3 – severe systemic disease
4. Class 4 – incapacitating systemic disease that is a threat to life
5. Class 5 – moribund patient who is not expected to live without surgery Emergency
144
maximum tourniquet time
90-120 minutes;
after that, allow 5 minutes of perfusion for every half hour over
145
tourniquet contraindications
* Infection
* **Open fracture**
* Sickle cell disease
* Peripheral vascular disease
* **Recent arterial graft**
* Previous DVT
* Hypercoagulability
* **Skin grafts application where bleeding must be distinguished**
146
Seddon classification:
nerve damage
* **Neuropraxia** – nerve contusion resulting in conduction block that recovers promptly
* **Axonotmesis** – interruption of axons with distal Wallerian degeneration. Supporting connective tissue sheaths remain intact allowing regeneration.
* **Neurotmesis** – complete severance of the nerve that is irreversible
147
neuropraxia:
define
nerve contusion resulting in conduction block that recovers promptly
148
Axonotmesis:
define
* interruption of axons with distal Wallerian degeneration.
* Supporting connective tissue sheaths remain intact allowing regeneration.
149
Neurotmesis:
define
complete severance of the nerve that is irreversible
150
difference between INCISIONAL and EXCISIONAL biopsy
* **Incisional – only a portion** of the lesion is removed
* **Excisional – the entire** lesion is removed
151
different biopsy techniques
| (hint: 4)
* Punch
* Shave
* Curettage
* Surgical excision
152
bone stimulator:
how does it work
**Piezoelectric principle**
* side under compression makes a negative charge that leads to bone growth
* therefore, placing a cathode in a non-union site will stimulate growth
153
direction of the cut for reverse Wilson of the 5th metatarsal
Distal lateral to proximal medial
154
first to describe arthrodesis
| (not a triple)
Robert E. **Soule (1910)**
first described arthrodesis of PIPJ for correction of hammertoe deformity (*end-to-end arthrodesis)*
155
order for hammertoe surgery
Note: Perform a Kelikian push-up test to determine if the next step is required
* **(1) PIPJ**
* Tendon
* Dorsal capsule
* Collaterals
* Plantar capsule
* Arthroplasty
* **(2) MPJ**
* Hood
* Tendon
* Capsule
* Plantar plate
* **(3) PIPJ**
* Arthrodesis
156
joint implants:
purpose
Maintain space between bony surfaces
Relieve pain
157
lag time for osteomyelitis to show on x-ray
10-14 days
158
how to culture osteomyelitis
1. Take one culture from the infected bone, *and*
2. Take a second culture proximal to the clearance margin to ensure remaining bone is not infected
159
Brodie abscess:
define, treatment
* Subacute osteomyelitic lesion usually found in children; *well-circumscribed, lytic lesion with sclerotic borders found in the metaphysis, epiphysis, and rarely diaphysis.*
* Painful with periods of exacerbation and remission.
* Tx: curettage and packing with autologous bone
160
antibiotic beads:
define, and adjuvants
* PMMA or Poly(methyl methacrylate).
* Gentamycin or tobramycin are often used since they are heat stable with good diffusion coefficiencies.
* Vancomycin and cefazolin may also be used.
