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OITE Prep Fredericks > Foot Ankle/Hand 12OCT > Flashcards

Foot Ankle/Hand 12OCT Flashcards

1
Q

What drives the Cavovarus foot?

A

The plantarflexion of first ray- PL mainly (antagonists by weak TA)

  • Coleman blcok hindfoot corects then you can correct with forefoot osteotomy
  • NO correct- then need hindfoot osteotomy
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2
Q

Treatment for cavovarus foot

A
  • calc- lateral clsoing wedge- no flexible
  • PL to PB transfer
  • Lengthening procedure
  • Plantar flacia release
  • dorsiflexion osteotomy
  • Overload of lateral forefoot- stress fractures
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3
Q

Rigid flatfoot (PTTI) will need what

A

ARTHRODESIS- Triple

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4
Q

Orthosis for fixed versus NON fixed deformities:

A

For FIXED you simply support and accommodate

for mobile yo counteract

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5
Q

With corrected hindfoot in PTTI and forefoot varus (supintation) will need what?

A

Will need plantarflexion of the first ray some how (arthrodesis or osteoetomy (Cotton))

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6
Q

What transfer is used in conjunction with flatfoot surgery?

A

FDL transfer

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7
Q

DMAA normal shoulder be?

A

<8d

  • IF increase DMAA the need osteotomy distally is joint congruent
  • IF incrase DMAA and INCONGRUENT- needs lateral release, medial capsulorraphy
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8
Q

If you see OVERPRONATION on Hallux Valgus then

A

you know you have to do soft tissue release (laterally)

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9
Q

What is deformity of talar neck non-union or mal union with medial compression screws?

A

VARUS malunion

- will lose EVERSION

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10
Q

Camper Chiasm is where

A

When FDP goes thorugh FDS slips at level of PIP

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11
Q

How many strands do you need to have active motion protocol in flexor tendon repair

A
  • need at least 4
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12
Q

Where is A2 and A4 pulleys?

A

A2- Proximal proximal phalanx

A4- middle middle phalanx

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13
Q

When is tendon repair the weakest?

A

between 2-3 weeks( goes down before it goes up), dorsal placement is stronger, usually rupture at knots

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14
Q

LeDDY type of flexor tendon injury?

A

type 1- tendon to palm- disrupts the blood supply, have to get to it soon.
Type 2- most common- FDP to campers chiasm- don’t have to be as urgent

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15
Q

Proximal Pole of scaphoid and displaced?

A

DORSAL approach and ORIF (even if 1mm displaced)

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16
Q

ORIF scaphoid indications:

A
  • proximal pole
  • any displacement
  • humpback deformity
  • intrascaphoid angle greater than 35
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17
Q

What is position of wrist with scaphoid fracture occurs?

A

extension an radial deviation

- the proximal POLE has greatest risk for AVN

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18
Q

What is the scaphoid view?

A

PA, 30d extension, 20d ulnar deviation

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19
Q

What is the best study to look for union of scaphoid/

A

CT

Get an MR with

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20
Q

Non op scaphoid?

A
  • Non-displaced waist

- Distal poles

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21
Q

Proximal pole non-union after some time treatment in young person:

A
  • Need new vascular supply

- free vascularized medial femoral condyle graft

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22
Q

MFC graft

A
  • based on the descending genicular artery

- used for proximal pole non-union or non-union of scaphoid with AVN

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23
Q

What is most sensitive test for carpal tunnel?

A

Durkens compression test

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24
Q

Good prognostic factors for CTR?

A
  • nighttime symptoms,

- relief with steroid injections

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25
Q

What is associated with poor prognosis after CTR?

A 
EMG changes pre-op
NCV
- Sensory only- mild
- sensory and otor- modA
ANY EMG changes means CTR should be first line of treatment
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26
Q

NCV : increased latencies

A

DSL: >3.5
DML >4.3
any EMG changes makes it sever (fibrillations

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27
Q

Volar Middle PHalanx with NO tenosynovian flap?

A

Cross finger flap (use reverse cross finger when the exposed portion is DORSAL ratehr than volar)
- can also do reverse cross finger flap
(Moberg is a volar advancedment flap for thumb defects?

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28
Q

What does it mean when they report NO tenosynovium over tendons when asking about flaps

A

Means you CANNOT use skin graft to cover

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29
Q

Distal figner tip amps?

A

Transverse: (VY advancement, Moberg(thumb))
Dorsal Oblique: (VY OR bone shortening with volar flap
Volar Oblique: NO VY, so see cross finger flap, thenar flap, island flaps

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30
Q

What is a complication of a thenar flap?

A

Stiffness and adhesions

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31
Q

What about dorsal proximal thumb flap used to cover?

A

1st dorsal metacarpal arter flap

FDMA

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32
Q

A 60d Zplasty give you how much length?

A

75%

45d give you 50%

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33
Q

Absolute indications for replant:

A
  • children
  • thumb
  • multiple metacarpals (fingers)
  • wrist or proximal
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34
Q

Contraindications for replant?

A
  • crush a avulsion
  • segemental
  • prolong ischemia time (
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35
Q

Warm ischemia time

A

PROXIMAL to carpus- 6 hours

Cold is 12 hours

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36
Q

Distal to carpus ischemia time:

A

12 hours of warm

24 hours of cold

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37
Q

Orders of Structures for replant

A
  1. Bone
  2. Extensors
  3. flexors
  4. Artery
  5. Vein
  6. Nerve
  7. SKin
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38
Q

Leeaches questions?

A
  • Huiridin- anticoagulant
  • aueroguinosa hydrophillis
  • cipro and bactrim
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39
Q

What size gap do you have to nerve graft?

A

For greater thatn 2.5cm nerve defets

- if 7mm to 2.5 cm you can use collagen conduits or other grafts, greaterter athatn 2.5 need nerve graft

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40
Q

Which is most favoral nerve to repair in UE?

A

Radial» median»»ulnar is bad

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41
Q

What structure is vilated in dorsal PIP dislocation?

A

volar plate

- need to splint in flexion to approimate volar plate, NOT let swan neck occur

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42
Q

PIP fractrue dislocaiton, when to ORIF?

A

if greater than 40% of join invovled

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43
Q

With volar PIP dislocation splinting after reduction?

A
  • central slip is injury, need to splint in extension after reduction
  • if you Dont splint right you get boutinerres
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44
Q

Elsons test?

A

central slip injruy detection
- PIP at 90 degrees with extension the DIP will hyper extend via the lateral bands- central slip njry dur to lanteral bands falling forward

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45
Q

Hook of Hamate Fx: best view?

A

carpal tunnel view

  • chornic or delayed presenation: excision of HofH
  • parasthesia to small and ring
  • CT if not seen on plain films
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46
Q

Ulanr nerve compression

A
  • arcade of struthers
  • Medial intermuscule septum
    ME
  • Cubital tunne
  • FCU apaneurosis
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47
Q

Warternburgs Sign:

A

cant addcut toe SSF due to EDM unoppsoed- first sign of ulnar nerve neruopathy

48
Q

Froments sign?

A

Use FLP to hold paper pinch: Adductor pollicus is out, ulnar nerve deficits , appears AFTER Wartenburgs sign

49
Q

revision ulnar nerve transposition locations?

A

needs to be sub muscular

50
Q

What is most common ulnar nerve entrapment at guyon?

A

ganglion cyst

51
Q

Fleshy nodules on the dorsal joints associated with Dupuytresn treatments?

A

DO NOTHING

52
Q

What it type of colagen in dupuytrenas and cell type

A

Type III and myofibroblasts

53
Q

Operative indications for Dupuytrens

A

> 30mcp, ANY PIP contractures

54
Q

Nerve is PUshed centrally and Volarly

A 
SPIRAL CORD (spiral band is nomrla structure)
spiral cord causes the the PIP
55
Q

Pretendionus cord is where?

A

is in the palm and cases MCP joint contracture (central Cord)

56
Q

What causes webspace contracture in duputryns ?

A

Natatory chord

cords are pathologic, bands are normal

57
Q

Herpetic Whitlow buzz fingers words:

A
  • herpetic whitlow- TX is observtion or Acyclovir
  • no I&D
  • Acyclovir
  • Tzank Prep
  • vesicular ting on fingers
  • dental hygenist, toddlers
58
Q

Typical bacteria for Nec Fasc?

A

Group A Strep

  • dishwater puss
  • how quikcly to I&D
59
Q

Atypical Mycobateria- insideious onset: what type of staining

A

Zeihl Nielsen staining

60
Q

Lowenstien-Jensen stain/culture medium?

A

used for atypical mycobacterium

-

61
Q

SLAC_ scapho-lunate advanced collapse

A
  • SL ligament injury at some point
    1. radial scahpoid
    2. entire radioscahpoid
    3. capitolunate joint (
    radiolunate joint is usuallly preserved
62
Q

When can yo NOT do the PRC?

A
  • when the proximal capitate is alreayd arthritic-
  • would need to do a four corner fusion
  • when you see narrowing at the mid-carpal joint you CANT do PRC- if not scaphoid excision at 4cf
63
Q

Dorsal Hand Wound reconstruction?

A
  • Groin flap
  • reverse radial forearm flap (needs intact Allens Test)
  • Posterior interosseous artery flap
64
Q

Kienbocks associated with ulnar variances?

A
  • ulnar negative variance, can sometimes shorten the radius
65
Q

Staging system of Kienbocks?

A
  1. no changes on Xray, only MRI
  2. Sclerosis no collapse
    3A- COLAPSE
    3B- collapse and rotaiton of scaphoid
    4- endstage arthritis
66
Q

Radial core decomprssion for keinboacks stage?

A

Stage II- NO collapse, sclerosis

can also do joint leveling procedures - if ulnar negative (radial shortening osteotomy)

67
Q

Stage III Kienbocks

A

you have lunate collapse
Stage iiiA-
Stage IIIB: PRC, fixed rotation of the scaphoid

68
Q

What makes the lunate too far gone in Kienbocks for salvage?

A

Fixed scaphoid rotaiton- keinbocks

69
Q

CRPS vitamin C dosing (prevention)

A

500mg for 8 weeks

70
Q

EPL rupture are non-op radius treatment- tendon transfer?

A

EIP transfer

71
Q

Tendon rputures ove a volar plate?

A

FPL> FDP to the index

72
Q

Lumbriclas attached where?

A

From FDP to the RADIAL Lateral band
- if you disarticualr the DIP, FDP retract, pulle on lumbricle to radial lateral band. Will paradoxical EXTENSION of PIP when making a fist
TX: release of radial lateral band

73
Q

Bennet Fractrue reduction manuever?

A

Traction, IR, ABDuction

  • deforming forcces are APL and Adductor pollicis
  • volar oblique ligamanet
74
Q

The most common location for metatarsal fracture in patient <5 yo?

A

The 1st Metatarsal

75
Q

Claw two treatment based on what?

A

Flexible or non-flexible (MTP Hyper extension, PIP/DIP flexion)
Flexible- FDL transfer (tendon transfers)
Non Flexible- Osteotomyies, capsulotomies

76
Q

What improves the wear properties of polyethylelne the most?

A

Gamma Irradiation

- Cross linking in inert gas

77
Q

ACtive form of Vitamin D?

A

1.25- dihydroxycholecalciferol

78
Q

Unique Aspect of 1st and 2nd Lumbricals?

A

Unipenate
- Arise from the radial aspect of Profundus
ALL insert on lateral band

79
Q

Normal Sensory Latency?

A

<3.5ms

80
Q

What is hypothenar hammer syndrome?

A

Injury, ulnar artery aneurysm at Guyon canal . Can lead to digital artery necrosis. Surgery if DBI < 0.7

81
Q

General Electrodiagnostic parameters of Carpal Tunnel?

A

Distal Motor Latency >4.5ms
Distal Sensory Latency > 3.5ms
NCV <52m/s

82
Q

What is involved in Dupuytryen contracture? Graysons or Clelands?

A

Graysons ligament

- More volar than Clelands

83
Q

What is the treatment of Giancell Tumor Of tendon Sheath?

A

Marginal Excision- recurrance is high with complete excision

84
Q

In treatment of CMC arthritis, when should you combine a MCP joint arthrodesis with CMC resection arthroplasty?

A

With MCP hyper extension >30d

85
Q

Progression of SLAC wrist (Scapho-lunate advnaced collapse?

A

1- Scaphoid- radiostyoid

  1. Works Radio-scaphoid to llunate
  2. Proximal Migration of the Capitate- lunate capitte
86
Q

Intersection Syndrome occurs where and between what dorsal compartments ?

A

Between 1st and s@nd (APL,EPB) and ECRL/ECRB

87
Q

AIN muscle innervation?

A

FPL
Radial FDP
Pronator Quadratus

88
Q

How long can you Non-op Pediatric trigger thumb?

A

Don’t have to do surgery until 2 years old

89
Q

EMG changes on preop EMG in CTR symptoms at one year?

A

20%

90
Q

What contributes to web space contracture in Dupuytrens?

A

Natatory cord

91
Q

What ligament is involved in dupytyrens? Clelands or graysons?

A

Graysons

92
Q

What happens when central slip is injured?

A

Lateral bands move more volar, flx PIP, extend DIP- Boutineres

93
Q

What does a lumbarical do to MCP, PIP, DIP?

A

Caused MCP flexion
PIP/DIP Extension
Attached to FDP

94
Q

What is NOT out in PIN versus radial nerve palsy at level of wrist?

A

ECRL is supplied by the radial nerve
PIN pretty much supplies every thing else common extensors, deep extensors
FCR–> finger extensors
Palmaris__> EPL

95
Q

What anatomic structure must be excised during volar plate arthroplasty?

A

Collateral ligament

96
Q

Flexion contractures that involve the PIP joint of small finger

A

Camptodactyly

  • non op for <30d
  • FDS tenotomy /transfer
97
Q

What do you do when EPL rupture with ND radius fracture? Fix or transfer

A

EIP to EPL

- usually nutritional in nature,

98
Q

radial to ulnar ligaments looking from 3,4 portal

A

Radial (RSC->LRL–>SRL)

99
Q

Leddy Type of Flexor Tendon Injuries?

A

Type I: Retracts to the level of the palm- Vincula is disrupted and needs to be fixed within 1 week

Type II: Retaracts to Level of PIP- Held out by FDS and vincula- Can be fixed up to 6 weeks

100
Q

What Symptoms are good prognositc indicators for relief following CTS?

A

NIGHTTIME SYMPTOMS

RElief with CSI

101
Q

Replant Times? Proximal to Carpus and distal to carpus

PROXIMAL TO CARPUS?

A

Warm- 6 hours

Cold 12 HOurs

102
Q

Distal to Carpus Amputaiton?

A

Warm: 12 hours
Cold: 24 hours

103
Q

Leeches Complication?

A

Aeromonas Hydrophilia

BACTRIM OR CIRPO

104
Q

Arcade of Struthers Compresses what Nerve?

A

Ulnar Nerve

At level of proxmal IM septum

105
Q

Arcade of Frosh Compresses what nerve?

A

PIN ( radial Nerve)

The proximal portion of the suppinator muscle

106
Q

What nerve is most at Risk in elevating Groin Flap ?

A

Elevated on superficial circumflex A

and Lateral femoral cutaneous N is at risk

107
Q

What is the vessel that supplies that Lattisimus Flap?

A

Thoracodorsal A.

108
Q

Operative INidcations for Dupys?

A

30 degrees at MCP

ANy contracture at PIP

109
Q

What is most common organism of Nec Fasc?

A

Group A Beta Hemolytic Strep ( GABHS)

110
Q

Inidcations for Palmar Fascia Release in Dupy?

A

MCP >20-30

PIP ANY Flexion

111
Q 
Structures that case Flexion in Dupy
PIP?
DIP?
Web Space?
MCP?
A

PIP- Spiral Chord
MCP: Central Chord
Web Space? Natatory chord
DIP: Retirvascular chord

112
Q

Gram Stain of P Acnes?

A

Gram Positive
Anaerobic Bacillis

Lives IN skin not ON it

113
Q

What is stainless steel made of?

A 
IRON
CARBON
CHROMIUM
NICKEL
MAGNENESE
MOLYBBENUM
114
Q

What is cobalt chrome made out of?

A

Cobalt
Chrom
Molybdenum `

115
Q

enneking of MSTS Staging System?

A 
I- Low grade
II- High Grade
A- Intracompartmental
B- Extracompartmental
III Metastatic

OITE Prep Fredericks (15 decks)

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