Surgery Flashcards
Indications for use of prophylactic antibiotic use (8)
1)Implants
2)Prolonged surgery
3)Trauma surgery
4)Revisional surgery
5)Immunocompromised patient
6)Extensive dissection
7) intra-operative contamination
8) endocarditis
Most commonly used antibiotics (3)
Ancef
Clindamycin (if PCN allergy)
Vancomycin (MRSA worry)
Indications for chest Xray (4)
40 years of age, smoker, any history of cardiac disease, any history of pulmonary disease
Indications for ordering an ECG (2)
> 40 years of age, any history of cardiac disease
Most common time post op for myocardial infarction
Day 3
How long should elective surgery be delayed following an MI or CABG
6 months
What should be obtained prior to surgery on a patient with Rheumatoid
cervical spine x-ray
When should aspirin be d/c prior to surgery
7 days due to irreversible binding to platelets
When should NSAIDs be d/c prior to surgery
3 days due to reversible binding to platelys
When should heparin be d/c prior to surgery
8 hours
When to d/c coumadin prior to surgery
3-4 days
What should INR be for elective surgeries
<1.4
Order of wound graft closure (4)
1) direct closure
2) graft
3)local flap
4) distant flap
Stages of skin graft healing (4)
1)Plasmatic
2) Inosculation of blood vessels
3) Re-organization
4) re-innervation
AO principles
1)anatomic reduction
2)rigid internal fixation
3) preservation of blood supply
4) early ROM
What are steps necessary for inserting a fully threaded screw (6)
1)overdrill near cortex
2) underdrill through far cortex
3) countersink
4)measure
5)tap
6)screw
Amount of screw to pass the far cortex
1.5 threads
Purpose of tapping
to create a path for the screw threads
Why countersink screw
Prevents stress risers and soft tissue irritation .
Provides even compression from screw head
Describe a mini fragment screw
Screw sizes of: 1.5, 2.0, 2.7
All fully threaded cortical screws
What are the differences between cortical and cancellous screws
Cortical has smaller pitch
Cortical has smaller rake angle
Cortical has smaller difference between thread diameter and core diameter
Describe a Malleolar screw
For fixation of medial malleolus, partially threaded, same thread profile and pitch as cortical screw, trephedine self cutting tipping
What screw has a fluted tip
self-tapping
Overdrill, underdrill and countersink for 1.5 mini fragment(fully threaded)
overdrill- 1.5
Underdrill- 1.1
Countersink 1.5
Overdrill, underdrill and countersink for 2.0 mini fragment (fully threaded)
Overdrill- 2.0
Underdrill- 1.5
Countersink- 2.0
Overdrill, underdrill and countersink for 2.7 mini fragment (fully threaded_
Overdrill- 2.7
Underdrill- 2.0
Countersink- 2.7
Overdrill, underdrill and countersink for 3.5 small fragment
overdrill 3.5
underdrill 2.5
countersink- 3.5
Overdrill, underdrill and countersink for 4.0 small fragment (fully thread)
overdrill 4.0
underdrill 2.5
countersink 4.0
Overdrill, underdrill and countersink for 4.0 small fragment (partial thread)
overdrill- 4.0
underdrill- 2.5
countersink 4.0
Overdrill, underdrill and countersink for 4.5 large fragment. Malleolar or non (same measurements )
Overdrill 4.5
underdrill 3.2
countersink 4.5
Overdrill, underdrill and countersink for 6.5 large fragment (partial or fully threaded)
overdrill 6.5
underdrill 3.2
countersink 6.5
What are steps for inserting a 4.0 cannulated screw (7 steps)
1) insert 1.3mm guide pin to far cortex
2) Measure
3) drill near cortex with 4.0 cannulated bit
4) Drill far cortex with 2.7 cannulated bit
5) tap
6) countersink
7)screw
What is a herbert screw
Headless screw- can be inserted through articular cartilage.
Threaded portion proximally and distally with smooth portion in between.
Proximal portion has tighter pitch for compression
Reese screw
Headless- create compression through arthrodesis.
Proximal threads run clockwise, and distal threads run counterclockwise.
What are K-wire sizes and widths in millimeters
.028 size- .6 width
.035 size- .9 width
.045 size- 1.2 width
.062 size- 1.6 width
What are the K-wire sizes and their appropriate caps
Young Boys Wear Green
.028-yellow
.035-blue
.045-white
.062-green
What are sizes for Steinman pins
5/64-12/64 (11/64 is skipped)
Different types of plate fixation (4)
Compression, Neutralization, Anti-glide, Buttress
Characteristics of compression plate (4)
1)Provides axial compression of fracture
2) Pre-bend plate
3) Eccentric drilling of hole adjacent to fracture, remaining holes drilled centrally
4) Place plate on tension side of bone
Characteristics of Neutralization plate (3)
1) Protects against shearing, bending and torsional forces at the fracture site
2)interfragmental compression obtained by lag screws
3) all holes drilled centrally
Characteristics of Anti- glide
neutralization plate placed on the posterior aspect of the fibula
Characteristic of Buttress plate (2)
1) Maintains alignment of unstable fracture fragments
2) no interfragmental compression
Which side of a fracture should the plate be placed
tension side
Is tension side of a met on the dorsal or plantar aspect?
Plantar aspect
What is a locking plate
Plate in which threaded screws are secured into threaded plate holes
Does not rely on bone for stability, but rather forms a fixed- angle construct
Good for osteoporotic, comminuted fractures, or revision surgeries
Define Hooke law
For a material under load, strain is proportional to stress
What is Young Modulus
after a load is removed, the material springs back to its original shape.
The resulting slope represents the stiffness of a material
