Ian Mayne 21-40 Flashcards
Describe the blood supply to the Achilles Tendon (3):
- Posterior Tibial Artery (Major)
- Paratenon
- Peroneal Artery
Watershed area 4-6cm proximal to Calcaneal insertion
List 4 fractures associated with a Lis-franc injury:
- 2nd MT #
- Navicular #
- Medial Cuneiform #
- Cuboid #
List 3 non-Foot & Ankle Orthopedic manifestations of Charcot Marie Tooth Disease:
- Hip dysplasia
- Hand intrinsic weakness
- Scoliosis
In patients with Hip Fusion, what are the expected results with future conversion to THA (7)?
- Relief of pain in adjacent joints (lumbar spine, contralateral hip, ipsilateral knee)
- Correction of LLD (avg 2cm LLD in hip fusions)
- Improvement in ROM (still lower than primary THA)
- Prolonged recovery (up to 2 years)
- Improvement in gait (independence of cane/walkers depends on mobility pre-op)
- Similar survivorship as Primary THA (if pt >50 years-old and has not had multiple hip surgeries surrounding the
fusion) - Higher rate of Infection
List the 4 muscle imbalances of the Lower Extremity in Charcot Marie Tooth disease
- PL strong over TA weak
- PL strong over PB weak
- Weak intrinsics
- Weak anterior compartment
List 5 contra-indications to a corrective osteotomy for a Distal Radius Malunion:
- Radiocarpal arthritis
- Intercarpal arthritis
- Fixed DISI
- Severe osteoporosis
- CRPS
- Low-demand patient
What are 3 strategies to improve the fixation of posterior spine instrumentation in patients with Osteoporosis?
- Longer fusion constructs
- Avoiding constructs that start or end at the cervicothoracic/thoracolumbar junction
- > 3 fixation points above and below the apex of the deformity
- Hybrid constructs (pedicle screws, hooks, wires
- Iliac and/or sacral fixation in long fusion constructs is recommended, when feasible
- Anterior column support increases load-sharing, decreases strain on constructs
- Pedicle screw purchase in subchondral bone (eg, sacral promontory)
- Under-tapping pedicle screws.
- Hubbing of pedicle screws adversely affects pullout strength and should be avoided.
List the 8 scales of the SF-36 health survey:
- Vitality
- physical functioning
- bodily pain
- general health perceptions
- physical role functioning
- emotional role functioning
- social role functioning
- mental health
List 8 ways to increase the stability of an external-fixator construct:
- contact of ends of fracture
- larger diameter pins (most important)
- additional pins
- decreased bone to rod distance
- pins in different planes
- increasing size or stacking rods
- rods in different planes
- increased spacing between pins
List 3 types of joint lubrication and bearing/surface example of each one:
- hydrodynamic: Metal on Metal / Ceramic on Ceramic
- elastohydrodynamic: Native Joints
- boundary: Metal on Poly**
What are the SSx’s of a Recurrent Laryngeal Nerve injury post-Anterior Cervical spine surgery?
- Unilateral Injury: hoarseness, microaspiration, coughing
- Bilateral Injury: aphonia, dyspneaàinadequate airwayàTracheostomy
List 3 reasons to get an MRI in a facet dislocation before performing a closed reduction/fixation:
- Rule out disc
- Signal change in cord
- Vertebral artery anatomy/injury
When assessing a patient with metastatic disease of the spine, what a 4 principles to consider surrounding your
management plan?
- Neurologic status
- Oncology
- Mechanical stability
- Systemic Disease
List the radiographic (x-ray and MRI) findings of a Charcot Spinal Arthropathy:
- soft-tissue mass with bone debris replacing the normal disc space
- sclerotic and destructive changes in the vertebral bodies and facet joints
- enlarging paraspinal mass with calcifications
- calcification within the spinal canal
- Low signal on T1 and T2 weighted MRI-KEY DIFFERENTIATING IMAGING FEATURE (osteosclerotic changes
and the presence of surrounding bony debris)
List 5 diagnoses that have a similar radiographic appearance to a Charcot Spinal Arthropathy:
- severe degenerative arthritis
- septic discitis
- osteomyelitis
- tumour
- Paget disease
Regarding Charcot Neuroarthropathy in the Diabetic:
When does is usually present in Type 1 and Type 2 Diabetics?
Time of Presentation:
* Type 1: 5th decade, after 20-24 years of Diabetes
* Type 2: 6th decade, after 5-9 years of Diabetes
Regarding Charcot Neuroarthropathy in the Diabetic:
What joints are most affected?
Most common joint affected:
* Tarsometatarsal joints
Regarding Charcot Neuroarthropathy in the Diabetic:
Resulting Deformity (2)?
- Fixed Rocker bottom foot
- Valgus
Regarding Charcot Neuroarthropathy in the Diabetic:
Treatment plan according to Eichenholtz Classification (3)?
Treatment Plan (Eichenholtz)
-
Fragmentation: Total contact casting, NWB, weekly cast changes. Lasts approx. 2-4 months. Progress to next
stage once erythema/swelling/skin temp normalize - Coalescence: CROW boot, WBAT
- Resolution: Diabetic shoe, Surgical reconstructionàexostectomy, deformity recon, arthrodesis, amputation
Deep infection/osteomyelitis without a skin ulcer is very RARE
List the abnormal changes/measurements during intra-operative Neuro monitoring (MEP, SSEP, EMG)
MEP
* 50% decrease in amplitude, 10% increase in latency
SSEP
* 50-75% decrease in amplitude, 10% increase in latency
EMG
* Cervical <10ma
* Thoracic <8ma
* Lumbar <7ma
List 4 poor prognostic factors after an Osteochondral allograft transfer for chronic post-traumatic intra-articular
deformity:
- > 50 years
- bipolar defects (ie, allograft transplantation for two articulating osteochondral defects)
- workers’ compensation cases
- residual lower extremity malalignment
List 5 risk factors for TKA extensor mechanism disruption:
- Revision surgery
- Patella Baja/Prior HTO
- Systemic: Renal disease, steroids, DM
- Injury during surgery
- Obese
- Trauma
List the 3 ligaments that makeup the “PCL Complex”:
- Ligament of Humphry
- Posterior Cruciate Ligament
- Ligament of Wrisberg
