Surgery

Question 1

What are the steps in a lateral release when performing a bunionectomy?

Answer 1

Release of

1. Adductor hallucis tendon
2. Fibular sesmoidal (suspensory) ligament
3. Tenotomy of the lateral head of the flexor hallucis brevis
4. Excision of the fibular sesamoid

Question 2

Why do we countersink before placing screws?

Answer 2

Prevent stress fractures

Allow the head of the screw to lay flush with the bone and avoid irritation

Question 3

What are some causes of a screw being too loose? How could you fix it?

Answer 3

Screw is too short and didn’t bite the distal cortex; screw diameter is too small; bad bone stock

Get a larger screw; use a washer

Question 4

What do you prescribe a child for post-op pain?

Answer 4

Tylenol 3

Question 5

How long do you make the arms in a V to Y lengthening procedure?

Answer 5

Twice as long as the gap you are trying to close

Question 6

Through which method could you fix a medial-posterior talar osteochondral defect if it was located too posteriorly to be accessed through any of the typical ports?

Answer 6

Medial mal take-down

Question 7

What are ankle tourniquets set to? What about thigh tourniquets? Why?

Answer 7

Ankle: 250 mmHg (100 above systolic BP)
Thigh: 300 mmHG (150 above systolic BP)

Question 8

How long can you keep a tourniquet on?

Answer 8

2 hours. After 2 hours you must take it down for 30 minutes. Then can put it back up.

Question 9

What are the causes of a blanched toe post-surgery? How do you fix it?

Answer 9

Bandage is too tight; extensive vascular damage; vasculature caught in suture (arterial problem)

Release the bandage; put limb in dependent position; twist the K-wire; apply heat to small of back; PT block; remove K-wire; remove dressing and consider opening wound/nifedipine with aspirin 81mg.

Question 10

What are the causes of a blue toe post-surgery? How do you fix it?

Answer 10

Venous problem

Elevate toe; lossen bandage; twist K-wire; remove K-wire; remove dressing, consider opening wound

Question 11

What is the depth of the 1st tarsometatarsal joint? The depth of the 2nd? The depth of the 3rd?

Answer 11

1st TMTJ: 32mm
2nd TMTJ: 27mm
2rd TMTJ: 24mm

Question 12

Why use a lazy S incision when fixing hammer toes?

Answer 12

To reduce post-surgical contracture

Question 13

How should the hallux be placed during a 1st MTPJ fusion?

Answer 13

15-20 degrees of dorsiflexion and 10-20 degrees of valgus

Question 14

If you accidentally cut the dorsalis pedis, what do you do?

Answer 14

Nothing, there are enough anastomoses to compensate.

Question 15

What is the max dose of 0.5 % marcaine?

- if with Epi?

Answer 15

35cc

45cc w epi

Question 16

What is a .062in K wire in millimeters ?

Answer 16

1.6

Question 17

Describe a buried knot?

Answer 17

From Deep to superficial then from superficial to deep.

Question 18

Is a monocryl suture braided or not?

Answer 18

Not!

Question 19

Is the vicryl suture braided?

Answer 19

Yes!