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Pot Pourri Flashcards

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
Q

What is a tibiotalar fusion called?

A

Blair fusion

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26
Q

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?

A

distraction-compression fusion

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27
Q

What is the double calcaneal osteotomy?

A

Evans with a medial calcaneal slide

indicated for a RF valgus and FF abudction

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28
Q

What is the order in which the effects of local anesthetics are felt?

A
  1. loss of pain and temp sensation
  2. loss of proprioception
  3. loss of touch and pressure sensation
  4. motor paralysis
29
Q

What properties are provided by a bone graft?

A

osteogenesis
osteoconduction
osteoinduction

30
Q

What does osteoconduction refer to?

A

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
Q

What does osteoinduction refer to?

A

recruitment of stem cells from the host bed into the graft site, where they differentiate into osteoblasts

32
Q

Describe the phases of bone graft healing.

A

inflammation
revascularization
osteogenesis
remodeling

33
Q

What is the mechanism of action of colchicine with respect to gout?

A

produces anti-inflammatory effect by inhibiting leukocyte migration and phagocytosis (via inhibition of microtubule aggregation)

34
Q

What are the classes of drugs used to treat gout?

A

xanthine oxidase inhbitiors (Allopurinol &Febuxostat)

uricosuric drugs- promotes excretion of uric acid (Probenecid & Sulfinpyrazone)

35
Q

What is included in an admission order?

A

ADC VANDILMAX
Admission, Diagnosis, Condition, Vitals, Ambulatory status, nursing instructions, diet, Ins/outs/IVs, Labs, Meds, Ancillary consults, Xrays/imaging

36
Q

What is the cockroft and gault fault?

A

(measures creatinine clearance)

140-age in years) x (weight in kg) / (72 x serum creatinine) x0.85 (if female

37
Q

What class of drug is Metformin? MOA?

A

biguanide- it decreases production of glucose in the liver

38
Q

What class of drug is Glipizide?MOA?

A

sulfonylurea- inhibits ATP-sensitive K+ channels of beta-cell –> depolarization –> Ca2+ dependent exocytosis of insulin, stimulating insulin release

39
Q

“pencil-in-cup” deformity is pathognomonic for what disease process?

A

psoriatic arthritis

-also has “sausage toes” and nail pitting/splitting

40
Q

what derm manifestation is seen in Reiter’s syndrome/ reactive arthritis?

A

keratoderm blennorrhagicum- describes a pustular lesion on the sole of the foot

41
Q

Compare and contrast OA vs. RA.

A

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
Q

What are ways to achieve compression when using plates?

A

eccentric drilling
prebending
tension device
tension band

43
Q

What are signs of hypoglycemia?

A 
diaphoresis/syncope
tachycardia, palpitations
hunger
anxiety, irritability 
tremors
weakness
mental confusion 
seizures
headache
44
Q

What are early radiographic signs of osteomyelitis?

A

osteolysis
cortical erosions
periosteal reaction
(OM takes 2 weeks to show up on xray after there has been 50% loss of bone)

45
Q

Differentiate between sequestrum, involucrum, and cloaca.

A

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
Q

What is Brodie’s abscess?

A

a chronic abscess in bone surrounded by dense fibrous tissue and sclerotic bone, most commonly found in the metaphysis

47
Q

What type of offloading device can be used to offload ulcers located in the posterior
heel?

A

multipodus splint

Prevalon boot

48
Q

What are some indications for hyperbaric oxygen therapy?

A 
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
Q

how do you evaluate someone to see if they will benefit from HBO?

A

transcutaneous oxygen monitoring (TCOMs)

if the TCOM reading is

50
Q

What 4 things are released in a lateral release?

A

ADH
fibular suspensory ligament
deep transverse intermetatarsal ligament
lateral collateral ligament

51
Q

causes of hallux varus?

A 
staking the head 
aggressive medial capsulorraphy 
fibular sesamoidectomy
aggessive post-op bandaging
lateral capsulotomy
52
Q

How should you orient your axis guidewire in an Austin if you want to plantarflex the 1st met?

A

orient the guidewire so that it is facing down

superior pole is dorsal media

53
Q

Where is the watershed region for the Achilles tendon? What is the significance of this?

A

2-6cm proximal to the insertion on the calcaneus

*site of AT ruptures

54
Q

What is the signifiance of repairing the paratenon when performing Achilles tendon repairs?

A

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
Q

Eccentric training for posterior muscle group is best shown to relieve what type of retrocalcaneal pathology?

A

Achilles tendinosis (mid-substance)

56
Q

what nerve is not blocked in a popliteal block?

A

saphenous n. (becomes it comes from a branch of the femoral n. that doesn’t pass thru the popliteal fossa)

57
Q

What is Engle’s angle?

A

quick estimation of met adductus angle
(normal is 18 deg)
Engle’s angle overestimates the MAA by 3-4 deg

58
Q

What is the true IMA if a patient has met adductus?

A

true IMA= (MAA- 15) + IMA

59
Q

What are the 3 FDA-approved antibiotics for treating diabetic foot infections?

A

(the 3 Z’s)
Invanz (Ertapenem)
Zyvox (Linezolid)
Zosyn (piperacillin/ tazobactam)

60
Q

What abx are hepatically cleared?

A

(the 3C’s)
Chloramphenicol
Clindamycin
Erythromycin

61
Q

What are the gas-producing bacterium?

A

BECKSP

bacteroides, E. coli, Clostridium, Staph, Strep, Streptopeptococcus, Serratia, Klebsiella, Peptococcus

62
Q

what radiographic view could you used to better evaluate a suspected talocalcaneal coalition?

A

Harris and Beath views

63
Q

Describe the congenital vertical talus deformity.

A

(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
Q

what does OATS stand for?

A

(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
Q

what size OCD lesion is the upper limit for microfracture repair/stimulation of fibrocartilage formation?

A

15mm (cited by Choi)

66
Q

what is coonrad bugg trap?

A

interpositionof soft tissue (tibialis posterio) in severe ankle fx

67
Q

what is a spontaneous AVN of the navicular in adults called?

A

Muller-Weiss disease

in children, it is called Kohler’s

68
Q

Ganglion cysts can often be misdiagnosed for what concerning thing?

A

synovial sarcoma

69
Q

What is the average depth of medial cuneiform?

A

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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