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Dave SG - Questions Flashcards

1
Q

What are the 3 red flags for suture station?

A
  1. Losing control of your sharp (needle)
  2. Picking up an instrument after putting in down (DONT PUT ANYTHING DOWN)
  3. Grasping the needle tip w/ your fingers or the needle driver (use the pickups)
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2
Q

Classify Vicryl suture

A
  • Absorbable
  • Synthetic
  • Braided multifilament
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3
Q

Name 5 different types of synthetic suture

A
  • Dexon
  • PDS (Polydiaxonone)
  • Maxon
  • Monocril
  • Vicryl

“DPM Motor Vehicle” - Vanity Plate, Fake? Synthetic

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4
Q

What type of Suture has the longest absorption rate?

A

Maxon→ Hydrolyzed in 180 days (Maximum)

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5
Q

What types of suture are best for closure of infected skin wounds?

A
  • Polypropylene → can be used in contaminated/infected wounds
    • Non-absorbable, synthetic, monofilaments are best in infected skin wounds
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6
Q

Name a specific brand of suture and type of suture technique that would be appropriate for closure of a joint capsule

A

Capsule closure → 2-0 or 3-0 Vicryl

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7
Q

Arrange the following in terms of size from thinnest to thickest:

fiberwire, nylon, vicryl

A

0 Fiberwire > 2-0 Vicryl > 4-0 Nylon

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8
Q

Is PDS suture monofilament or multifilament?

A

MONOFILAMENT

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9
Q

Identify the suture(s) technique used:

A
  • Left = Vertical mattress
  • Right = Interrupted Cruciate
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10
Q

Order of screw placement

A
  • 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”
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11
Q

Interfragmentary Compression Station - Objectives

A
  • 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
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12
Q

Identify 2 reasons for countersinking

A
  1. Increase the surface contact area of the screw head
  2. Make the screw head less prominent
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13
Q

Why do we always measure after countersinking?

A

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

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14
Q

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?

A

Switch to a 2.7mm screw, as the thread hole for that screw is 2.0mm

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15
Q

What is the pitch of a cortical screw?

A
  • Cortical screw = 1.25mm
  • Cancellous screw = 1.75mm
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16
Q

Anatomic boundaries of the nail matrix?

A
  • Distally to the LUNULA
  • Proximally to the DISTAL PORTION OF THE EXTENSOR RIDGE
  • Marginally from LATERAL CONDYLE to LATERAL CONDYLE
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17
Q

What is the difference between eponychium and hyponychium?

A
  • Hyponychium= distal free edge of the nail
  • Eponychium = proximal skin fold, NOT part of the nail matrix
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18
Q

In what clinical situations would the Winograd procedure be appropriate to perform?

A

Pediatrics and cases w/ hypergranular tissue

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19
Q

Steps of applying a tourniquet

A
  1. 4” Webril – 3-5 loops
  2. Apply tourniquet – Red for ankle, Brown for thigh
  3. Hook to machine
  4. Add 10-10 Drape for defining sterile/unsterile junction
  5. Scrub in
  6. Surgical Prep of the foot
  7. Blue towel to indicate sterile/ unsterile and towel clamp
  8. Esmarch to drain blood
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20
Q

5 layers of surgical dissection

A
  1. skin
  2. superficial fascia
  3. deep fascia
  4. periosteum
  5. bone
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21
Q

1st dissection interval

A

b/w superficial fascia and deep fascia

22
Q

2nd dissection interval

A

b/w deep fascia and periosteum

23
Q

3rd dissection interval

A

b/w periosteum and the bone

24
Q

incision tips

A
  1. Tangential incision w/ blade 90degrees to skin
  2. Lateral tension along incision line
  3. tip-belly -tip technique
25
what is found in 1st dissection interval? (b/w superficial fascia and deep fascia)
cutaneous nerves and superficial venous system (1st Interval)
26
what is found in 2nd interval? | (b/w deep fascia and periosteum)
muscles/tendons, arteries, deep veins and nerves (2nd interval)
27
what is found in the 3rd dissection interval? (b/w periosteum and bone)
cartilage
28
what is the target tissue in surgery?
bone
29
What is the major exception in digital anatomy?
ALL NEUROVASCULAR ELEMENTS are w/in the Superficial Fascia
30
**Joint capsule closure**: *how to close?*
* Absorbable suture, * Interrupted cruciate (2-0 or 3-0 Vicryl)
31
**Periosteum closure**: *how to close?*
* Interrupted cruciate w/ large absorbable suture (2-0 or 3-0 Vicryl)
32
**Deep fascia:** *how to close?*
* Interrupted cruciate w/ 2-0 or 3-0 Vicryl
33
**Superficial fascia**: *how to close?*
* Interrupted small diameter absorbable suture (3-0 or 4-0 Vicryl)
34
**Skin closure**: *how to close*
Interrupted w/ NON-absorbable suture
35
Suture style that gives the **MOST EVERSION** at the incision site?
Vertical Mattress interrupted suture
36
**Surgeons Knot**: *describe it*
* Square knot = functional unit, locks in tension
37
**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
38
**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
39
**2nd digit:** *neurovascular elements*
* Plantar Med/Lat= Medial Plantar * Dorsal Med= Med. Terminal Branch of Deep Peroneal * Dorsal Lat= Medial Dorsal Cutaneous
40
**3rd digit**: *neurovascular elements*
* Plantar Med/Lat= Medial Plantar * Dorsal Med=Medial Dorsal Cutaneous * Dorsal Lat= Intermediate Dorsal Cutaneous
41
**4th digit:** *neurovascular elements*
* Plantar Med= Medial Plantar * Plantar Lat= Lateral Plantar * Dorsal Med/Lat= Intermediate Dorsal Cutaneous
42
**5th digit:** *neurovascular elements*
* Plantar Med/Lat= Lateral Plantar * Dorsal Med= Intermediate Dorsal Cutaneous * Dorsal Lat= Lateral Dorsal Cutaneous (Sural Nerve)
43
When is it more appropriate to do a total nail avulsion procedure?
Pathology that is \>50% of the nail
44
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
45
**Winograd incision**: ## Footnote *indications*
* pediatrics * hypergranular tissue
46
**Frost incision**: ## Footnote *indications*
better visualization of nail matrix w/ transverse arm of incision proximally
47
**Zadik** **incision:** *indications*
used for better visualization during permanent total nail avulsions
48
What are the **Acisional procedures**?
* Basic **partial nail** avulsion * **Bottlecap** total nail avulsion
49
Nail surgery post-Op care
* **Partial** = Epsom salt + warm water soaks 3x day for 20min * **Total nail**= no soaking, keep bandage dry/clean/intact
50
What are the 4 AO principles?
1. Fracture **reduction and fixation** to restore anatomical relationships 2. Stability by **fixation or splintage**, as the personality of the fracture and injury requires 3. **Preservation of the blood supply** to soft tissues and bone by careful handling and gentle reduction techniques 4. Early and safe **mobilization** of the part and the patient
51
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
52
Steps of interfrag compression
* Holding the proximal portion w/ head of the screw * Grabbing distal portion w/ threads of screw

Surgical Skills (5 decks)

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