Crozer Flashcards
What is the treatment for anaphylaxis?
Airway – bronchospasm
o O2 40-100%
o Epinephrine 0.3-0.5 mL 1:1000 soln SC or IM q15min
o Albuterol 0.5 mL 0.5% in 2.5 mL NS nebulized q15min
o Benadryl 50 mg PO q4-6h
o Methylprednisolone 2-60 mg PO daily
Cardiovascular – hypotension
o IV fluids 1 L q20-30min prn
o Maintain systolic pressure >80-100 mm Hg
o Epinephrine 1 mg 1:1000 in 500 mL D5W IV at rate of 0.25-2.5 mL/min
o Norepinephrine 4mg in 1 L D5W IV at 0.5-3 mL/min
o Benadryl 50 mg PO q4-6h
Cutaneous reactions
o Epinephrine 1:1000 0.3-0.5 mL SC or IM q15min
o Benadryl 50 mg PO q4-6h
Document offending agent and educate patient on future avoidance
What is the difference between anaphylaxis and anaphylactoid reaction?
Clinically, they present the same, but anaphylactoid reaction is not mediated by the IgE antibody
and does not necessarily require previous exposure to the inciting substance
What are some absolute indications for a fasciotomy for compartment syndrome?
Tissue pressure above 30 mm Hg (normal 4 ± 4 mm Hg)
Sensory and motor loss
Pain out of proportion
How do you do a leg fasciotomy?
To do a leg fasciotomy, make one incision medial to the tibia and one lateral.
From the medial incision, open the superficial and deep posterior compartments. From the
lateral incision, open the anterior and lateral compartments
What are some techniques for measuring compartment pressure?
Wick catheter, slit catheter, Synthes catheter, needle technique, continuous infusion technique.
But as stated before, this should be a clinical diagnosis
what and Why tibialis anterior tendon transfer
Note: The STATT is slightly preferred due to fewer complications.
Indications: To decrease forefoot supinatory twist
To increase true ankle DF
Procedure:
1. TA is detached from its insertion
2. Reroute and insert it into lateral cuneiform or 3rd metatarsal (or inserted into peroneus
tertius if present)
What is Tachdjian-Grice
Note: Grice procedure = STJ arthrodesis
Indications: Congenital convex pes planovalgus (vertical talus!) + Ages 4-6 years old
Procedure:
1. First stage: TAL with posterior ankle and STJ capsular release
2. Second stage: (3 weeks later) STJ extraarticular arthrodesis
What is Stoffel
Indication: Correction of spastic muscular forms o
STATT
Note: Same as TATT but only half the tendon is used. See Special Surgery Section for details.
Indications: To increase true ankle DF and decrease long extensor swing phase
To decrease adductovarus forefoot
Procedure:
1. Detach half of TA from its insertion
2. Reroute and insert it into peroneus tertius (or cuboid, if peroneus tertius isn’t present)
Silver and Simon
Indication: Spastic equinus
Procedure:
1. Proximal release of gastroc without reinsertion of heads
2. Neurectomy of tibial branches to medial head of gastroc
OATS (Osteoarticular Transfer System)
Indication: Posterior medial talar dome osteochondral lesion
Procedure:
1. Take a plug of bone with articular cartilage from the knee
2. Through a trans-tibial approach, insert it into the talus (matching the contours of cartilage
on graft to dome of talus)
Murphy prodecure
Indication: Spastic equinus
Procedure: Anterior transfer of TA into calcaneus
Modification – route under FHL
Jones Procedure
Indications: Cock-up hallux Weak TA (procedure enhances DF) Procedure: 1. EHL is detached and inserted into 1st metatarsal head via a med → lat drill hole 2. IPJ fusion 3. Stump of EHL is attached to EHB
Hoffman-Clayton
Indications: MPJ subluxation secondary to rheumatoid arthritis and fat pad atrophy
Procedure: Resection of metatarsal heads 2-5 and bases of proximal phalanxes
Hoffman
Note: Often done with Keller arthroplasty
Indications: MPJ subluxation secondary to rheumatoid arthritis and fat pad atrophy
Procedure: Resection of metatarsal heads 2-5
Hibbs
Indication: To decrease MPJ buckling and increase DF
Procedure:
1. EDL is detached from insertion and reattached to lateral cuneiform or 3rd metatarsal
2. Distal stubs of EDL are attached to EDB at metatarsal head area
brostrom-gould in nutshell
Procedure:
1. Incise lateral ankle capsule 2-3 cm distal to lateral malleolus
2. Evert foot and tighten capsule including ATFL and CFL in pants over vest fashion with
non-absorbable suture
3. Mobilize extensor retinaculum, pull it over capsule and suture down
christman snook
Note: Could use PL instead of PB for this procedure
Indication: Lateral ankle instability
To reinforce ATFL and CFL
Procedure:
1. Detach half of PB from its insertion
2. Reroute it through a drill hole in the talar neck and distal lateral malleolus (through
widest part, anterior to posterior). Suture graft tendon to periosteal flap at level of CFL.
3. Distal half of PB then sutured to proximal half
Young Tenosuspension
Note: Often done in conjunction with other procedures
Indications: Pes planus + Age 10 years or older
Patients with navicular-cuneiform fault but no DJD yet
Helps to PF 1st ray (takes away TA antagonist action against PL)
Procedures:
1. TAL
2. Reroute TA through keyhole in navicular (do not detach TA from insertion)
a. Alternate – detach TA from insertion and reattach after passing through a trephine
hole in navicular
3. TP reattachment beneath navicular (creates a powerful plantar navicular-cuneiform
ligament)
Chambers
Indication: Flexible pes planus (more often in children, <8 years old)
Rarely performed anymore
Procedure:
1. TAL
2. Bone graft under sinus tarsi (similar to location of arthroereisis to block translocation of
talus on the calcaneus)
Tongue in groove cut in aponeurosis
Baker
Louisan-Balaceau
CBWO
crescentic direction
Crescentic osteotomy, (with crescentic blade) concavity directed proximally
hohmann, reverse hohmann
Note: Reverse Hohmann used for Tailor’s bunion
Indications: HAV
Procedure: Through and through transverse osteotomy at the metatarsal neck (unstable
osteotomy)
Keller in detail
Note: Used in patients >50-55 years old
Indications: HAV (IMA 16° or less) + Hallux limitus/rigidus
Procedure: Resection of the proximal ¼ to ⅓ base proximal phalanx (⅓ more commonly, cut
perpendicular to long axis of bone), and cheilectomy with capsular tissue sewn
into 1st MPJ space
Kessel-Bonney
Indication: Hallux limitus
Procedure: Removal of a pie-shaped dorsiflexory wedge of bone from proximal phalanx
Lambrinudi
Indication: Hallux limitus
Procedure: Plantarflexory wedge osteotomy of 1st metatarsal base
Logroscino
Indications: HAV (IMA ≥15° in rectus foot, 13° with adductus) + Abnormal PASA
Procedure:
1. CBWO (or Crescentic) → to correct HAV
2. Reverdin (or Peabody) → to correct cartilage orientation
Mitchell
Indication: HAV
Procedure: Distal metaphyseal osteotomy with rectangular block of bone removed and
preservation of lateral cortical ―spur‖ (width of spur varied depending on amount
of correction needed) that hangs over shaft when transposed.
why us mra in lower extremity
PVD, DVT, neoplasm and anatomic studies
Most commonly ordered by a vascular surgeon for further description of occlusions/stenosis
AVN on MRI
T1 and T2
Decreased signal intensities
STIR and Long T2
Double rim sign: Inner margin will show an increased signal intensity (this represents
granulation tissue). Outer margin will show decreased signal intensity (this shows
mineralization).
OM on MRI
T1
Break in cortex, decreased signal in the bone marrow
T2
Break in cortex, increased signal in the bone marrow
stress fracture on MRI
T1
Linear zone of decreased signal intensity surrounded by a less defined area of signal
intensity
T2
Linear zone of decreased signal intensity surrounded by an increased signal intensity due
to edema
STIR
Increased signal intensity because fatty bone marrow is suppressed
For MRI, what are the main indications for STIR imaging?
It is useful for evaluation of edema in high lipid regions, such as bone marrow.
It is also useful for evaluating cartilage.
