Surgery Flashcards
Biologic fixation recommended in:
maintain length and alignment Comminuted fracture fragments lag screw would result in fragment devitalization gap in fracture and a plate will be used to maintain the relative position of fragments
Biologic fixation:
not stable, requires soft tissue attachments and blood supply of comminuted fragments union depends on bridging callus rather than primary bone union
Biologic fixation technique:
- reposition and realign fracture, preserve soft tissue 2. leave comminution fragments out of mechanical construct (pieces should have vascular supply)
- biocompatible materials
- minimum contact btwn bone and implant
- limiting operative exposure when possible
Perioperative adrenal suppression
short ACTH stim test: reliable assess adrenocortical function –>abnormal: supplemental periop glucocorticoid —>normal, risk for adrenal insufficiency (unexplained hypotension despite volume depletion): steroid dose consistent w/ injury continue steroid until stress response diminished (48 hrs)
Supplemental glucocorticoid dose for foot surgeries
100mg methylprednisone pre-op severe disease or extensive procedure –> continue and taper after surgery
Thompson Procedure
indicated in underlapping fifth toe Z-type incision dorsally over proximal phalanx + resection of 5th proximal phalanx + resection of fifth proximal phalanx + reefing of capsule to fill dead space + corrective closure Z incision
Disuse osteopenia
transient periarticular osteopenia can be seen with ankle arthrodiastasis
Ankle arthrodiastasis
the use of hinges along the malleolar axis of an external fixator are debatable
Skin flap viability test
Fluorescein dye study most accurate predictor 18 hrs after injection
surgical care of diabetic limb threatening infection should be addressed within ____ hours after admission.
6 over 6 hours related to higher risk of amputation proximal to ankle
Aspirin prophylaxis
81-325 mg ASA as primary or secondary prophylaxis continue preoperatively, with the exception of intracranial, middle ear, posterior eye or intramedullary spine surgery and possibly in prostate surgery
Stainless steel
Chromium (major) > nickel > molybdenum
Advantages of diaphysis osteotomy for callus distraction
easier access, well defined osteotomy, easier manipulation of periosteum, less mechanical strength, less metabolic activity
Advantages of metaphysis osteotomy for callus distraction
greater surface area –> greater stability and strength, increased vascularity and osteogenic potential more difficult to manipulate periosteum
Nail bed lacerations can be replaced within ___ days
7 after 7 days, presence of granulation tissue and contracture
Phases of distraction
- initiation (osteotomy and fixator placement) 2. latency (5-10 days depending on location) 3. distraction (1mm in 24 hr in four incriments) 4. consolidation
Digital fillet flaps cover an estimated ___
15.6 sq cm
Wilson V-Y skin plasty disadvantage:
undercorrection deformity exceeds amount of skin advancement
Indication for Jones suspension procedure
Transfer of EHL through head of 1st met medial to lateral Indications: flexible cavus foot, flexible plantarflexed first ray, prophylaxis when hallucal sesamoids are removed Won’t treat rigid deformity of hypermobile first ray
Cerclage wire methods
Twist knot has the greatest resistance to failure increased wire diameter increased load to failure values
Techniques for circular skin defect
O-T closure, O-Z closure, mercedes benz closure
Ponsetti method
Cavus, Adductus, Varus, Equinus
Cavus: correct the pronation of forefoot in relation to hindfoot by supinating forefoot (which elevates 1st ray)
Adductus: by abducting midfoot in the transverse plane, midfoot abducted under the talus (apply counterpressure with thumb against talus)
Varus: will be corrected when foot is entirely abducted
Equinus: by dorsiflexion of foot by perc tenotomy of AT
Use toe to groin casts, not below the knee casts
Fifth metatarsal fractures most common to least
Most common: avulsion fracture of 5th met base (51.2%)
Transverse shaft (16%)
Jones (13%)
Spiral oblique (11%)
Zone 3 (6%)
Second Hit Phenomenon
sequential insults can lead to overwhelming physiologic reactions
What obscures the view of the anterior and middle facet during subtalar joint arthroscopy?
interosseus talocalcaneal ligament
Risk factors for EKG pre op
men over 40 and women over 50 with risk factor (CHF, IDDM, ischemic cardiac disease, CVD, CHF, creatinine > 2mg/dl)
Indications for supramalleolar osteotomies
periarticular tibial deformity
malunion of ankle arthrodesis
subtalar deformity with concomittant ankle arthrosis
ankle osteoarthritis with concomittant valgus deformity
Contra-indications for supramalleolar osteotomies
talar tilt over 10 degrees
end-stage degenerative changes of ankle joint
unmanagemeable hindfoot instability
neuropathic disorders
Best surgical procedure for HAV in CP patient
1st MPJ fusion (McKeever)
Bridle procedure
Tri-tendon anastomosis (TP, TA, PL)
for flexible equinus and equinovarus or flaccid foot
better dorsiflexion power found in McCall study
Procedure: TP passed through longitudinal incision in TA. PL is harvested, then passed subcutaneously to the TP and TA anastomosis and secured.
Condrocyte survivability with fresh osteochondral allografts
90% after 14 days
70% after 28.5 days
