Random Learning Flashcards
What makes a foot at high risk?
PAD
LOPS
Deformity, history of ulcerations.
Topical anti-fungal
Terbinafine (brand name Lamisil)
Oral anti-fungal
Lamisil
Lamisil interacts/affects what?
Liver.
Maybe warfarin, cholesterol drugs, anti-seizure drugs (any drugs cleared by liver).
How does the body get rid of warfarin?
Metabolized by liver
indomethacine
oral NSAID for gouty attacks
colchicine
alkaloid anti inflammatory can be used to prevent gout attacks or address a gout attack
Diameter of lesion that causes suspicion for melanoma?
greater than 6mm
What is recommended daily intake of protein for wound healing?
1.5g/kg
compartment syndrome diagnosis needs a pressure measurement of
30 mmHG or higher
Remove the nail if subungual hematoma is
50% of nail or 25% of nail with fracture
Tendon…
transfer
transposition
transplantation
suspension
transfer = detachment at insertion and moved elsewhere
transposition = no detachment, but rerouted. AKA translocation.
transplantation = detachment at both ends & moved.
tendon suspension = procedures to support tendon; i.e. graft wrap.
According to CPMAgram, looking at ankle mortise view… Syndesmotic injury is suspected if tib fib clear space is ___ and tib fib overlap is ___
Syndesmotic injury is suspected if tib fib clear space is greater than 6mm and tib fib overlap is less than 1mm.
Cotton Stress Test
Used to test syndesmotic injury.
Syndesmotic injury occurs 1% of the time in ankle injuries.
Cotton stress test has 25% sensitivity. No specificity % noted.
Stabilize the leg and push the foot laterally. If >3-5mm translation, then suspect syndesmotic injury.
Source: https://www.physiotutors.com/wiki/cotton-test/
Vit D normal levels
20-40 ng/mL
Albumin
Albumin is protein in your plasma that can indicate liver/kidney function/ ability to heal. High usually means dehydration. Normal levels are 3.5-5.5 g/dL.
HA1c measurement of ___ means you should cancel surgery
Higher than 8%
Youngswick Austin is modified chevron that takes additional dorsal wedge out allowing for further correction in the sagital plane via
plantar displacement and 1st ray shortening
Youngswick Austin plantar arm placement. How does angle of plantar arm affect plantar displacement?
The larger the angle of the plantar arm, the more plantar displacement achieved.
Plantar arm 0 degree angle will allow 0 plantar displacement.
In Austin osteotomy, what direction should the saw blade be angulated to provide shortening and plantarflexion?
distal dorsal medial to proximal plantar lateral
Presence of metatarsus adductus does what to the true IM angle?
What is formula?
Decreases the true IM angle. True IMA should be larger.
So true IMA = IMA + MAA - 15
Or true IMA = IMA + Engel’s - 24
How do you measure Engel’s angle?
DP view of the foot. longitudinal axis of 2nd met and longitudinal axis of the intermediate cuneiform
How do you draw the metatarsus adductus angle?
The presence
of metatarsus adductus was defined as
either a metatarsus adductus angle larger than 15 degrees or an Engel’s angle larger than 24 degrees
os interphalangeus
The os interphalangeus is found at the hallux interphalangeal joint; it is rare to see it at the interphalangeal joints of the lesser toes. The ossicle is located most commonly along the inferior aspect of the interphalangeal joint centrally and is round or oval in shape
dime sign
The “dime sign” is a radiographic marker best visualized on the ankle mortise view where a dime placed laterally should uniformly touch the peroneal groove of the distal fibula and the lateral talar process. Asymmetry is usually associated with fibular fracture shortening that must be reconstructed intraoperatively.
Pilon fracture
Tibial plafond fracture
Tillaux-Chaput
Avulsion of tibia attached to AITFL
Wagstaff
Avulsion of fibula attached to AITFL
Volkmann fracture
Avulsion of tibia attached to PITFL
Dupuytren fracture
talus wedged between tibia & fibula
Supination Adduction stages
- lateral injury
- medial injury
Supination External Rotation stages
- syndesmosis
- lateral; weber B, spiral/oblique fx
- posterior injury
- medial injury
Pronation Abduction
- Medial; Transverse fracture/Widening of medial gutter
- Syndesmosis
- Lateral; Weber C
Pronation external rotation
- Medial; transverse fx
- Syndesmosis
- Lateral; Weber C
- posterior
How do you close reduce an ankle fracture?
Use Charnley principles. Increase deformity, distract, reverse the mechanism. Then cast/splint. Patient will need strong pain meds for procedure.
Which principles say that fixating the primary fragment, assuming soft tissue is intact and functioning, will help align everything else based on natural anatomic pull? Example: fixating the posterior malleolus when the PITFL is intact.
Vassal rule / ligamentotaxis
What is sequence for hammertoe surgery
Head
Extensor
Capsulotomy
Arthrodesis
Plantar plate
Principles of AO fixation
atraumatic technique
anatomic reduction
stable fixation
early range of motion
Steps to screw fixation
- Overdrill near cortex
- Underdrill through far cortex
- Countersink
- Measure
- Tap
- Screw
Do you stop metformin before surgery?
You should stop metformin 2 days before and after surgery to prevent lactic acidosis. Bridge inbetween.
Hardcastle classification
Lisfranc injury
A. total incongruity (entire forefoot dislocation)
B. partial incongruity
1. medial (just 1st ray)
2. lateral
C. divergent
1. partial
2. total
Percocet prescription
oxycodone/acetaminophen 5/325mg
1-2 tabs PO q4-6h PRN pain
Lisfranc displacement of larger than __ indicates instability and need for ORIF
2mm
