Dave SG - Questions Flashcards
What are the 3 red flags for suture station?
- Losing control of your sharp (needle)
- Picking up an instrument after putting in down (DONT PUT ANYTHING DOWN)
- Grasping the needle tip w/ your fingers or the needle driver (use the pickups)
Classify Vicryl suture
- Absorbable
- Synthetic
- Braided multifilament
Name 5 different types of synthetic suture
- Dexon
- PDS (Polydiaxonone)
- Maxon
- Monocril
- Vicryl
“DPM Motor Vehicle” - Vanity Plate, Fake? Synthetic
What type of Suture has the longest absorption rate?
Maxon→ Hydrolyzed in 180 days (Maximum)
What types of suture are best for closure of infected skin wounds?
-
Polypropylene → can be used in contaminated/infected wounds
- Non-absorbable, synthetic, monofilaments are best in infected skin wounds
Name a specific brand of suture and type of suture technique that would be appropriate for closure of a joint capsule
Capsule closure → 2-0 or 3-0 Vicryl
Arrange the following in terms of size from thinnest to thickest:
fiberwire, nylon, vicryl
0 Fiberwire > 2-0 Vicryl > 4-0 Nylon
Is PDS suture monofilament or multifilament?
MONOFILAMENT
Identify the suture(s) technique used:
- Left = Vertical mattress
- Right = Interrupted Cruciate
Order of screw placement
- Overdrill→ only through proximal cortex, Glide Hole
- Underdrill→ both cortices, Thread Hole
- Countersink→ prepare near cortex for screw head
- Measure → w/ depth gauge
- Tap→ cuts thread pattern for screw
- Screw → “two-finger tightness”
Interfragmentary Compression Station - Objectives
- Load each of the instruments into the hand piece using the quick-release technique
- Identify each of the instruments needed to generate interfragmentary compression
- Perform interfragmentary compression using the correct instruments, in the correct order
Identify 2 reasons for countersinking
- Increase the surface contact area of the screw head
- Make the screw head less prominent
Why do we always measure after countersinking?
Because countersinking physically removes bone and will shorten the size of screw needed→ measuring before countersinking will lead to using a screw that is too long
You are in a surgical case and plan on using a 2.0mm screw to fixate an osteotomy, but accidentally overdrill through both the near and far cortex. What options do you now have to generate interfragmentary compression through this hole?
Switch to a 2.7mm screw, as the thread hole for that screw is 2.0mm
What is the pitch of a cortical screw?
- Cortical screw = 1.25mm
- Cancellous screw = 1.75mm
Anatomic boundaries of the nail matrix?
- Distally to the LUNULA
- Proximally to the DISTAL PORTION OF THE EXTENSOR RIDGE
- Marginally from LATERAL CONDYLE to LATERAL CONDYLE
What is the difference between eponychium and hyponychium?
- Hyponychium= distal free edge of the nail
- Eponychium = proximal skin fold, NOT part of the nail matrix
In what clinical situations would the Winograd procedure be appropriate to perform?
Pediatrics and cases w/ hypergranular tissue
Steps of applying a tourniquet
- 4” Webril – 3-5 loops
- Apply tourniquet – Red for ankle, Brown for thigh
- Hook to machine
- Add 10-10 Drape for defining sterile/unsterile junction
- Scrub in
- Surgical Prep of the foot
- Blue towel to indicate sterile/ unsterile and towel clamp
- Esmarch to drain blood
5 layers of surgical dissection
- skin
- superficial fascia
- deep fascia
- periosteum
- bone
1st dissection interval
b/w superficial fascia and deep fascia
2nd dissection interval
b/w deep fascia and periosteum
3rd dissection interval
b/w periosteum and the bone
incision tips
- Tangential incision w/ blade 90degrees to skin
- Lateral tension along incision line
- tip-belly -tip technique
what is found in 1st dissection interval?
(b/w superficial fascia and deep fascia)
cutaneous nerves and superficial venous system (1st Interval)
what is found in 2nd interval?
(b/w deep fascia and periosteum)
muscles/tendons, arteries, deep veins and nerves (2nd interval)
what is found in the 3rd dissection interval?
(b/w periosteum and bone)
cartilage
what is the target tissue in surgery?
bone
What is the major exception in digital anatomy?
ALL NEUROVASCULAR ELEMENTS are w/in the Superficial Fascia
Joint capsule closure: how to close?
- Absorbable suture,
- Interrupted cruciate (2-0 or 3-0 Vicryl)
Periosteum closure: how to close?
- Interrupted cruciate w/ large absorbable suture (2-0 or 3-0 Vicryl)
Deep fascia: how to close?
- Interrupted cruciate w/ 2-0 or 3-0 Vicryl
Superficial fascia: how to close?
- Interrupted small diameter absorbable suture (3-0 or 4-0 Vicryl)
Skin closure: how to close
Interrupted w/ NON-absorbable suture
Suture style that gives the MOST EVERSION at the incision site?
Vertical Mattress interrupted suture
Surgeons Knot: describe it
- Square knot = functional unit, locks in tension
Neurovascular elements: overview
- Each digit has a neurovascular bundle in each of the 4 corners
- w/in the superficial fascia
- Neuro supply in each digit
Hallux: neurovascular elements
- Plantar medial/lateral= Medial Plantar
- Dorsal medial= Proper dorsal digital branch of Medial Dorsal Cutaneous
- Dorsal lateral= Med. Terminal Branch of Deep Peroneal
2nd digit: neurovascular elements
- Plantar Med/Lat= Medial Plantar
- Dorsal Med= Med. Terminal Branch of Deep Peroneal
- Dorsal Lat= Medial Dorsal Cutaneous
3rd digit: neurovascular elements
- Plantar Med/Lat= Medial Plantar
- Dorsal Med=Medial Dorsal Cutaneous
- Dorsal Lat= Intermediate Dorsal Cutaneous
4th digit: neurovascular elements
- Plantar Med= Medial Plantar
- Plantar Lat= Lateral Plantar
- Dorsal Med/Lat= Intermediate Dorsal Cutaneous
5th digit: neurovascular elements
- Plantar Med/Lat= Lateral Plantar
- Dorsal Med= Intermediate Dorsal Cutaneous
- Dorsal Lat= Lateral Dorsal Cutaneous (Sural Nerve)
When is it more appropriate to do a total nail avulsion procedure?
Pathology that is >50% of the nail
Describe permanent total nail avulsion
- Involves a matrixectomy
- Either cold steel, laser, cryotherapy, or w/ phenol
- Phenol is contraindicated in acute infection
Phenol → 3x 60 sec applications
Winograd incision:
indications
- pediatrics
- hypergranular tissue
Frost incision:
indications
better visualization of nail matrix w/ transverse arm of incision proximally
Zadik incision:
indications
used for better visualization during permanent total nail avulsions
What are the Acisional procedures?
- Basic partial nail avulsion
- Bottlecap total nail avulsion
Nail surgery post-Op care
- Partial = Epsom salt + warm water soaks 3x day for 20min
- Total nail= no soaking, keep bandage dry/clean/intact
What are the 4 AO principles?
- Fracture reduction and fixation to restore anatomical relationships
- Stability by fixation or splintage, as the personality of the fracture and injury requires
- Preservation of the blood supply to soft tissues and bone by careful handling and gentle reduction techniques
- Early and safe mobilization of the part and the patient
What are the 4 AO Stabilization Rules?
- Screw Fixation → match screw size to size of the bone (proper diameter, length of threads, screw length)
-
Plate Stability
- 3-4 cortices distally, 5-6 cortices proximally
- Vassal Rule→ reduce/fixate dominant fracture first
Steps of interfrag compression
- Holding the proximal portion w/ head of the screw
- Grabbing distal portion w/ threads of screw
