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1
Q

What are the 4 AO principles of internal fixation?

A
  1. anatomic reduction
  2. stable internal fixation
  3. preservation of blood supply
  4. early, active, pain-free ROM
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2
Q

Where does the blood supply to the bone cone from?

A

periosteum- supplies outer 1/3 of cortical bone

endosteal or medullary vessels (nutrient artery)- supply inner 2/3 of cortical bone

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3
Q

which type of healing heals with callus formation?

A

secondary healing (or indirect healing)

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4
Q

what is primary (or direct) healing?

A

bypasses callus formation; occurs with absolute stability ; utilizes cutting cones

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5
Q

what are the differences in bone healing between cortical and cancellous bone?

A

cortical- undergoes secondary healing (w/ callus formation)

cancellous- no significant callus formation due to tremendous angiogenic potential of trabecular bone

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6
Q

What is AO technique- lag screw by technique?

A

overdrill, underdrill, countersink, measure

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7
Q

Which step of AO technique does lag screw by design take out?

A

overdrill

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8
Q

Where is the apex of deformity in metatarsus adductus?

A

Lisfranc’s joint (tarsometatarsal joint)

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9
Q

Describe the levels of deformity in the skewfoot.

A

transverse plane adduction
frontal plane inversion
rearfoot eversion

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10
Q

What are the stages of Eichenholtz for charcot neuroarthropthy?

A

stage 0- at risk for Charcot (e.g. neuropathic diabetic w/ acute sprain or fx)
stage 1- development/fragmentation (red, hot swollen foot; xray shows multiple fractures and subluxation)
stage 2- coalescence (absorption of fine debris; sclerosis of bone ends)
stage 3- reconstruction/consolidation (remodeling of bone)

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11
Q

Describe the stages of Brodsky classification.

A 
Type 1 (most common)- Lisfranc's (tarsometatarsal) joint
Type 2- Chopart's/ STJ 
Type 3a- ankle
Type 3b- calcaneus
Type 4- multiple regions
Type 5- forefoot
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12
Q

What are the 3 currently FDA approved meds for treating diabetic foot infection?

A
  1. Zyvox (LInezolid)
  2. Zosyn (Piperacillin/tazobactam)
  3. Invanz (Ertapenem)
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13
Q

Give a verbal description of the types of Achilles rupture repairs.

A

Krakow- interlocking
Bunnell- crosses
Kessel- a box

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14
Q

What is Burrow’s triangle?

A

a wedge of skin and subcutaneous fat excised, usually at the end of a closed wound and created by flap transfer or advancement, so that a smooth repair can be obtained.

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15
Q

What is Virchow’s triad?

A
  1. stasis
  2. endothelial damage
  3. hypercoagulability
    (all are factors predisposing to a thrombus)
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16
Q

trade name for bupivicaine?

A

Exparel , Marcaine, Sensoricarine

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17
Q

What is Exparel?

A

is basically a fat-soluble type of lidocaine (liposome injectable suspension)

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18
Q

How are amides cleared? esters?

A

amides- cleared by the liver

esters- in the blood by cholinesterases

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19
Q

what is the correct order of correction for clubfoot using the Ponsetti casting method?

A
  1. cavus
  2. adduction
  3. equinus
    (*mnemonic- CAVE)
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20
Q

what are the main causes of graft failure?

A

hematoma
seroma
infection
shearing forces
*BONUS- how would you prevent these from happening?
fenestration- prevents hematoma/seroma
bolster dressing- helps with graft adhesion and prevents shearing forces

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21
Q

What angles are used to evaluate a Calc fracture? how do they change in a calcaneal fracture?

A

Bohler’s angle (normal 25-40)- decreases w/ a calc fx

Critical angle of gissane (normal- 120-145)- increases w/ a calc fx

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22
Q

What is the max. dose of lidocaine? (w/ epi and w/o)?

A

w/o epi: 4.5mg/kg or up to 300mg

w/ epi: 7mg/kg or up to 500mg

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23
Q

What is the max. dose of marcaine? (w/ epi and w/o)?

A

w/o epi: 2.5mg/kg or up to 175 mg

w/ epi: 3.2mg/ kg or up to 225mg

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24
Q

What is a pantalar fusion?

A

fusion of the tibiotalar, subtalar, talonavicular and calcaneocuboid joints

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25
What is a tibiotalar fusion called?
Blair fusion
26
What is the ankle fusion technique that is indicated in a child to preserve the potential for growth of the distal tibia and fibular physis?
distraction-compression fusion
27
What is the double calcaneal osteotomy?
Evans with a medial calcaneal slide | indicated for a RF valgus and FF abudction
28
What is the order in which the effects of local anesthetics are felt?
1. loss of pain and temp sensation 2. loss of proprioception 3. loss of touch and pressure sensation 4. motor paralysis
29
What properties are provided by a bone graft?
osteogenesis osteoconduction osteoinduction
30
What does osteoconduction refer to?
bone graft or implant's ability to provide a structural framework on which host cells reconstitute *is a scaffold that enables ingrowth of vessels, osteoblasts, and stem cells so that union occurs with the host skeleton
31
What does osteoinduction refer to?
recruitment of stem cells from the host bed into the graft site, where they differentiate into osteoblasts
32
Describe the phases of bone graft healing.
inflammation revascularization osteogenesis remodeling
33
What is the mechanism of action of colchicine with respect to gout?
produces anti-inflammatory effect by inhibiting leukocyte migration and phagocytosis (via inhibition of microtubule aggregation)
34
What are the classes of drugs used to treat gout?
xanthine oxidase inhbitiors (Allopurinol &Febuxostat) | uricosuric drugs- promotes excretion of uric acid (Probenecid & Sulfinpyrazone)
35
What is included in an admission order?
ADC VANDILMAX Admission, Diagnosis, Condition, Vitals, Ambulatory status, nursing instructions, diet, Ins/outs/IVs, Labs, Meds, Ancillary consults, Xrays/imaging
36
What is the cockroft and gault fault?
(measures creatinine clearance) | 140-age in years) x (weight in kg) / (72 x serum creatinine) x0.85 (if female
37
What class of drug is Metformin? MOA?
biguanide- it decreases production of glucose in the liver
38
What class of drug is Glipizide?MOA?
sulfonylurea- inhibits ATP-sensitive K+ channels of beta-cell --> depolarization --> Ca2+ dependent exocytosis of insulin, stimulating insulin release
39
"pencil-in-cup" deformity is pathognomonic for what disease process?
psoriatic arthritis | -also has "sausage toes" and nail pitting/splitting
40
what derm manifestation is seen in Reiter's syndrome/ reactive arthritis?
keratoderm blennorrhagicum- describes a pustular lesion on the sole of the foot
41
Compare and contrast OA vs. RA.
RA- symmetric joint space narrowing; affects MPJ and PIPJ (but spares DIPJ) OA- asymmetric joint space narrowing; affects PIPJ and DIPJ (but spares MPJs)
42
What are ways to achieve compression when using plates?
eccentric drilling prebending tension device tension band
43
What are signs of hypoglycemia?
``` diaphoresis/syncope tachycardia, palpitations hunger anxiety, irritability tremors weakness mental confusion seizures headache ```
44
What are early radiographic signs of osteomyelitis?
osteolysis cortical erosions periosteal reaction (OM takes 2 weeks to show up on xray after there has been 50% loss of bone)
45
Differentiate between sequestrum, involucrum, and cloaca.
sequestrum- a piece of necrotic bone separated from living bone by granulation tissue Involucrum- a layer of living bone that has formed around the dead bone cloaca- a layer of living bone that may form a sinus and drain
46
What is Brodie's abscess?
a chronic abscess in bone surrounded by dense fibrous tissue and sclerotic bone, most commonly found in the metaphysis
47
What type of offloading device can be used to offload ulcers located in the posterior heel?
multipodus splint | Prevalon boot
48
What are some indications for hyperbaric oxygen therapy?
``` hypoxic ulcers (i.e. ulcers due to diabetes or arterial insufficiency) chronic refractory osteomyelitis necrotizing infections burns crush injuries compromised or failed flaps soft tissue radionecrosis ```
49
how do you evaluate someone to see if they will benefit from HBO?
transcutaneous oxygen monitoring (TCOMs) | if the TCOM reading is
50
What 4 things are released in a lateral release?
ADH fibular suspensory ligament deep transverse intermetatarsal ligament lateral collateral ligament
51
causes of hallux varus?
``` staking the head aggressive medial capsulorraphy fibular sesamoidectomy aggessive post-op bandaging lateral capsulotomy ```
52
How should you orient your axis guidewire in an Austin if you want to plantarflex the 1st met?
orient the guidewire so that it is facing down | superior pole is dorsal media
53
Where is the watershed region for the Achilles tendon? What is the significance of this?
2-6cm proximal to the insertion on the calcaneus | *site of AT ruptures
54
What is the signifiance of repairing the paratenon when performing Achilles tendon repairs?
paratenon permits gliding motion of the tendon as well as provides the VASCULAR supply to the tendon *it is important to tag the paratenon during sx so that you can repair it
55
Eccentric training for posterior muscle group is best shown to relieve what type of retrocalcaneal pathology?
Achilles tendinosis (mid-substance)
56
what nerve is not blocked in a popliteal block?
saphenous n. (becomes it comes from a branch of the femoral n. that doesn't pass thru the popliteal fossa)
57
What is Engle's angle?
quick estimation of met adductus angle (normal is 18 deg) Engle's angle overestimates the MAA by 3-4 deg
58
What is the true IMA if a patient has met adductus?
true IMA= (MAA- 15) + IMA
59
What are the 3 FDA-approved antibiotics for treating diabetic foot infections?
(the 3 Z's) Invanz (Ertapenem) Zyvox (Linezolid) Zosyn (piperacillin/ tazobactam)
60
What abx are hepatically cleared?
(the 3C's) Chloramphenicol Clindamycin Erythromycin
61
What are the gas-producing bacterium?
BECKSP | bacteroides, E. coli, Clostridium, Staph, Strep, Streptopeptococcus, Serratia, Klebsiella, Peptococcus
62
what radiographic view could you used to better evaluate a suspected talocalcaneal coalition?
Harris and Beath views
63
Describe the congenital vertical talus deformity.
(congenital rigid flatfoot) in which there is a fixed dorsal dislocation of the navicular on the head of the talus and a rigid equinus deformity of the hindfoot
64
what does OATS stand for?
(osteochondral autograft transfer system) - this procedure is adapated from knee procedures - The goal is to replace damaged cartilage and subchondralbone with an autologous graft that has similar biological and mechanical properties to the native hyaline articular cartilage
65
what size OCD lesion is the upper limit for microfracture repair/stimulation of fibrocartilage formation?
15mm (cited by Choi)
66
what is coonrad bugg trap?
interpositionof soft tissue (tibialis posterio) in severe ankle fx
67
what is a spontaneous AVN of the navicular in adults called?
Muller-Weiss disease | in children, it is called Kohler's
68
Ganglion cysts can often be misdiagnosed for what concerning thing?
synovial sarcoma
69
What is the average depth of medial cuneiform?
33mm (1/2- 1/4 inch) * based on Ryan et al, JFAS 2012 "Average depth of tarsometatarsal joint for trephine arthrodesis." * what is the average depth of a sagittal saw? 31mm (a little short)

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