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162 Cards in this Set
- Front
- Back
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how many bones in the foot
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26 (plus 2 for sesamoids)
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how many joints in the foot
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35
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AVN of tibial sesamoid
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renandier
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AVN of fibular sesamoid
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trevor
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AVN of phalanges
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Theiman
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AVN of cuneiforms
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Bushkes
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AVN of cuboid
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Lance
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AVN of talus
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Diaz
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Blounts dz
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AVN of the proximal medial tibial epiphysis
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AVN of tibial tuber
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Osgood Schlatters
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Legg Calve Perthes
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AVN of femoral epiphysis
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what is the MC coalition in the foot
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distal and middle phalanx of 5th digit
-MC in the RF is talocalcaneal |
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4 layers of foot from superficial to deep
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1. FAA (FDB,AbH,Ab digiti)
2. QP, lumbricals, FDL tendon 3. AFF (AddH, FDMB, FHB) 4. 2 DI, 3 PI |
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orgin and insertion of capsularis tendon
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O: EHL
I: 1st MPJ capsule |
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are the sesamoids capsular or extra-capsular
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capsular
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what structures in the lisfranc joint are not connected by ligaments
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1st and 2nd met (only support is the lisfranc ligament)
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what ligaments compose the bifurcate ligament and where does it run
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-calc nav
-calc cuboid Y shaped ligament at the anterior process of the calcaneus |
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components of deltoid ligament
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Superficial: posterior tibiotalar, tibionav, tibiocalc
Deep: posterior ligaments and anterior tibiotalar |
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angle of ATFL and CFL
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105
-atfl is taut in PF -cfl is taut in DF |
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what ligaments support the ankle sundesmosis
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-ant inf tib-fib
-post inf tib-fib -interosseous tib fib |
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what is the Bassett ligament
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-ant inf tib-fib ligament (syndesmosis)
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another name for flexor retinaculum, sup ext ret, inf ext retinaculm
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-flexor retinaculum: laciniate
(tarsal tunnel conents: Tom, Dick, AVN, Harry, ant-post) -sup ex ret: transverse crural (A HAND P; med to lat) -inf ext ret: cruciate crural |
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bakers cyst is formed in what tendons
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-medial head of gastroc and SM muscle
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what is in a CBC and include normal values for each
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WBC (4-10K)
Hb (14-16) Ht (30-40%) Platlets (150-350) |
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what is in a BMP and what are normal values for each
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Na - 135
Cl - 100 BUN: 10-20 K: 3-5 CO2 - 35 creatinine: .7-1.5 glucose: 100 |
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what do Na, Cl, K and CO2 tell you
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nutritional status
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what should be done if K is too high (greater then 5)
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manage dextrose with insulin
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normal values for PT/INR/PTT
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PT 12 sec
PTT 24 sec INR 1 |
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for anesthesia, what can't be given to pts with egg allergies
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diprivan (propofol)
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what effect do NSAID's have on anti-hypertensives
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-antagonize anti HTN meds
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fxn of biguanides and examples
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-anti hyperglycemia
-metformin, glucophage, janumet |
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glipizide and glyburide function and class
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sulfonylureas
-stimualtes beat cell insulin release |
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how many units of insulin do you give someone with BG of 150-200 and what is the trend
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4 units
- 2 units for every 30 over 120 |
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only 2 FDA drugs for treating DM neuropathy
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Cymbalta
Lyrica |
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you cant use allopurinol or probenecid for a gouty attack bc it can cause hyperuremia; what can u use
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-NSAIDS (indomethacin)
-colchicine -corticosteroids |
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what med do you give a uric acid overproducer? an undersecretor?
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Under Paid (probenecid)
Over Achiever (allopurinol) |
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what causes the fibular deviation (lateral deviation) seen in RA
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erosive changes in the medial plantar met heads compromising the medial collateral ligaments
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what is pannus found in RA joints
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-granualtion tissue that secretes chondrolytic enzymes that break down articular cartilage
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Pencil in Cup appearance
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Psoriatic Arthritis
(or atrophic charcot) |
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symmetric arthritis
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-RA
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Reiter Syndrome is HLA-B27 postive, what is present in synovial fluid analysis
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Pekin Cells
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radiographic signs of Reiters Syndrome
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-fluffy periosteal reactions
-large bilateral heel spur formation -inflammation and widening of achilles tendon insertion -deossifications |
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what foot related problem can ankylosing spondylitis pts present with
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heel pain
peripheral joint pain |
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painful, hot swollen joint; differ gout from septic arthritis
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-septic arthritis will have systemic symptoms (fever, chills, tachy, N/V)
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list some conditions associated with brachymet
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downs syndrome
turners syndrome cri du chat pseudohypothyroidism |
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why can you use a max of 1 cm graft to correct brachymet
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-more then that will cause stretching of NV structures
-use a mini rail if you need more |
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what is achondroplasia
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dwarfism; all bones are short wtih tibia undergrowth and fibula overgrowth causing genu varum
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what is apert symdrome
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multiple bony coaltions
-apoptosis between fingers and bones doesnt occur |
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what is pagets disease (osteitis deformans)
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imbalance between osteoclast and osteoblast
-presents as mosaic bone pattern |
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what malignant bone tumor may be seen with paget disease
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osteosarcoma
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DOC for nec fas
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Primaxin (imipenem/cilistatin)
500 mg IV q8 |
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What is Felty Syndrome
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RA
Big spleen (splenomegaly) leukopenia (low WBC) |
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how does erysipelas differ from cellultis
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-erysipelas has streaking and invades the lymphatics
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which steroids are insoluble and thus longer acting
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-acetate based
(kenalog) |
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what is a steroid flare that can occur after an injection
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-hypersensitivity reaction
-apply ice and can give NSAID |
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what is phenol
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carbolic acid
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what is Sullivans sign
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seperation of the digits caused by mass with in the interspace
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what are the stages of Reynauds vasospasm
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white - pallor from spasm of digital arteries
blue - cyanosis from deosygenation of blood pools red - rubor from hyperemia |
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what is the Q angle
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line between the axis of the femur and line b/w the patella and tibial tuberosity
N = 18-22, > for women |
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what is kaposi sarcoma
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-vascular malignancy
-purple plaques -nodules -high incidence in AIDS |
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what conditions may be associated with plantar fibromatosis
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-ledderhosen dz
-dupuytren contractures -peyronie dz (fibrosis and curvature of the penis) |
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CCPV = ?
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congenital convex pes valgus
- or vertical talus - or rigid rocker bottom foot |
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what is the most symptomatic coalition
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CN
(TN is the least symptomatic) |
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what ligaments/capsules and muscles/tendons are contracted in clubfoot (AVE)
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Posterior and medial ligaments
Anterior, Posterior and Medial tendons/muscles: achilles, plantaris, PT, FDL, FHL, AbH, TA |
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Generally how many casts are used for clubfoot and where is pressure applied during manipulation
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6-8 casts
-pressure is applied to the TALUS |
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what is Simons rule of 15
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for clubfoot:
T-C angle <15 T-1st met angle >15 (meary) |
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IM angle for head procedures
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mild 10-13
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IM angle for shaft procedures
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moderate 14-17
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IM angle for base procedures
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severe 18-21
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1st metatarsal-medial cuneiform angle
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N = 22
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Fallat & buckholz Angle
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4th IM Angle
-between the bisector of 4th and proximal medial border of 5th |
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normal and pathologic for Fallat & Buckholz angle
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N= 6
Pathologic = 8 |
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what is the Fallat and buckholz lateral deviation
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N = 2
pathologic >8 -angle between the center of 5th met head and prox medial base of 5th met |
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angles of splayfoot
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IM angle: >12
4th-5th IM angle: >8 |
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Kites angle
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-talo calc angle
20-40 inc with pronation dec with supination |
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Toyger angle
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-line drawn down the posterior aspect of the calcaneus
-should be a straight line(180) -dec with achilles rupture |
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pre-op orders for an In House patient
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-NPO after midnight
-AM meds with sip of water -hold all anti-coags -if IDDM give 1/2 amt insulin -begin 1/2NSS at 60 (D5W and 1/2NSS if DM) -CBC with diff, BMP, PT/PTT -CXR, EKG if necessary -consult medicine for clearance |
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what is the perioperative management for someone on high dose steroids
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-periop IV supplementation
-100 mg hydrocortisone given the night before, prior to sx, and then q8 until stress is relieved |
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when should aspirin be dc prior to sx
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7 days
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when should NSAID be dc prior to sx
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3 days
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INR for elective surgeries
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less then 1.4
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how much would 1 unit of FFP raise the INR
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0.2
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how much would PRBC raise Ht
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3
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Relaxed skin tension lines run what way to the long axis of the leg
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-perpendicular to the long axis (run medial to lateral)
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stages of skin graft healing
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1. plasmatic
2. revascularization 3. re-organization 4. re-innervation |
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how much of a screw should pass the far cortex
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1.5 threads
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what is the MC cx following an EPF (endoscopic fasciotomy)
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-lateral column instability and calc cuboid joint pain from cutting too far laterally
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what is the order of lateral release for a McBride
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Extensor hood
AddH fib ses lig lateral collateral lig FHB fib sesamoid excision |
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transverse plane procedures for pes planus
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-Evans
-Kouts -Kidner (TP to underside of navi) |
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sagittal plane procedures for pes planus
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-cotton: open wedge of med cune
-young: keyhole TA to navi -hoke: plantar wedge from navi and 2 cunes -miller: med column fuse -cobb; SPATT to TP |
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frontal plane procedures for flat foot
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-kouts
-dwyer -chambers; raise post STJ with graft under sinus tarsi -gleich -silver (lateral open wedge of calc for valgus) |
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surgical procedures for pes cavus
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Tendon
-Jones -Hibbs -STATT -PT Bone -DF osteot 1st met -Cole -japas |
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what is a valente procedure
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STJ block using polyethylene plug with screw threads (allows 4-5 degrees of STJ pronation, like the MBA)
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order of resection in a triple, order of fusion in a triple
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Resect Midtarsal (TN, CC) then STJ
Fuse opposite order: STJ, CC, TN |
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what does AVN look like on MRI
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-dec SI within meduallry canal on both T1 and T2
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ASA classification for general anesthesia
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class 1. healthy
2. mild systemic dz (DM) 3. severe systemic dz 4. incapacitating systemic dx 5. wont live w.o sx emergency |
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direction of cut for a reverse wilson of the 5th met
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distal lateral to proximal medial
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who was first to describe an arhtrodesis
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Soule
(Ryerson did the triple) |
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order for HT sx
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PIPJ (Extensor, capsule, collaterals, head)
MPJ (hood, extensor, capsule) PIPJ (arthrodesis) HEECAT |
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how to culture for OM
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take one from the infected bone and one more proximal to clearance margin to ensure remaining bone is not infected
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subacute osteomyeltic lesion and its treatment
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-Brodies abscess
-curette and pack with autogenous bone |
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what stages of berndt hardy are assoicated with lateral ankle ligament ruptures
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2,3,4
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transverse lat mall fx
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SAD 1
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short oblique med mall fx
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SAD 2
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short, oblique lat mall fx (tran on lateral)
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PAB 3
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SER 2
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spiral fib fx with posterior spike
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Lauge Hansen Type 5
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tibial mall. fx
ant tib lip fx fib fx transverse posterior tibia fx |
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when should a posterior malleolar fx be fixed
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-when >25% of the post mall
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MC , benign, primary bone tumor
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osteochondroma
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MC, malignant, primary bone tumor
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multiple myeloma
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Maffuccis disease
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-multiple enchondromas (olliers) with some tissue hemangiomas
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stages of wound healing and at what stage do chronic wounds become stuck
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1. inflammatory (d1-4)
2. proliferative (d3-21) - chronic wounds get stuck here 3. remodeling (up to 1 yr) |
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what is regranex
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Platelet derived growth factor (PDGF) - tissue remodeling and angiogenesis
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what are the following bioengineered tissues made out of
integra oasis apligraft graft jacket tissue mend |
integra - bovine tendon collagenand chondroiton sulfate
oasis - pig intestine apligraft- neonatal foreskin graft jacket - human tissue with intact vascular channels tissue mend - bovine dermis |
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describe how HAV occurs
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-excess pronation causes hypermobility of 1st ray. tibial sesamoid ligament gets stretched and fib ses contracts. lateral sublux of prox phalanx occurs.
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classification ofr hallux limitus
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Regnauld
1. functional limitus with dorsal spurring 2. broad, flat met head with joitn space narrowing 3. loss of joint space and motion, OCD |
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reduction sequence of lisfranc
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-realign the 2nd met on the medial cuneiform
-once that is stabilized the lesser mets should follow -then stabilize the 1st met and then the lesser mets |
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wafer shaped and associated with trauma
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lateral (easier to surgical access and correct)
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cup shaped and not associated with trauma
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medial talar dome lesion
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notes about LH classification
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SAD - only one that affects ATFL and not syndesmosis
SAD 2 - only vertical med mall fx SAD - below AJ SER,PAB - at AJ PER - above AJ S's have #2 hallmark P's have #3 hallmark SER, PER have 4 stages PAB has 3 SAD has 2 |
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AO system of ankle fractures
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a - extra articular
b - partially articular c - completely articular |
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which is the most common Salter Harris Physis fractures
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Thurston Holland sign of 2
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Conti classification
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MRI PT rupture
1. vertical splits and partial tears 2. partially torn and attenuated 3. rupture and gap |
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somogyi phenomenom
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hypoglycemia results in hyperglycemia (occurs in Type 1)
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what causes a thrombus
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-in DM hardened plaques in can artery can rupture the lining of the vessel before it completely blocks the vessel
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PMMA elution rate
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7% in first 24 hours, finished in 14 days (Cierny reccomends 1:5 ratio of abx to PMMA)
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what enzyme do humans lack, that prevents gout in other animals
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uricase oxidizes uric acid
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what three fractures are commonly associated with calc fractures
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-L1
-tibial plateua -femoral neck |
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3 surgical choices for talar dome lesion
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1. remove it
2. stimulate it with drilling 3. replace it with graft (OATS) |
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what does OATS stand for
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osteochondral autograft transfer system
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Dias classification for lateral ankle trauma (sprain)
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1. partial CFL tear
2. ATFL tear 3. rupture of all 3 4. rupture of all 3 with deltoid failure |
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salter harris that causes shortening or angulation
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type 3 (L) - through physis and epiphysis
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salter harris that causes joint deformity
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Type 4 (T) - intra articular fracture extending from epi, to physis up into the meta
-affects the growing layer of cartilage cells in the epi |
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salter harris that causes premature closure of the growth plate
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type 5 (E) - comminuted fracture from impaction of all 3 layers
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if closed reduction of physis isnt possible with salter harris 3-5; where should fixation be placed
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in the metaphysis
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johnson and strom stages
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PT tendon dysfunction
1. tendonitis and pain 2. attentuation or PT rupture, foot still felxible with Too many toe sign 3. complete PT rupture with rigid flat foot 4. rigid flatfoot with ankle involvement |
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what disease can you look for in blood pool phase
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-cellulitis
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what can you look for in delayed bone scan phase
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-bone activity (OM)
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what can you look for in late pahse (4th)
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bone uptake for PVD patient
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way to distibguish OM from Charcot
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ceratec or indium 111 scan (WBC labeled)
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what causes increase signal on T1
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fat
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what causes inc SI on T2
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F I I T
fluid inflammation infection tumor |
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how will osteo show up on MRI
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-break in cortex and dec in bone marrow intensity on T1
-break in cortex and inc SI on T2 |
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what does HMPAO stand for
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hexyl - methyl-propylene-amine-oxime
(tech 99-HMPAO, HMPAO attaches to WBC) |
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what does MDP stand for
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methyl-diphosphate
(Tech99-MDP, MDP attaches to bone) |
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hallux limitus procedures
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Kessel bonney- pie shape from dorsal phalanx
Lambrinudi - PFWO at base Keller McKeever |
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Juvara indications and procedure
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IM < 15
Oblique CBWO |
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loison -balaceau indications and procedures
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high IM
-CBWO right across the base of the 1st met, difficult to fixate, oblique CBWO (Juvara) is easier to fixate |
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indication for McKeever (MPJ fusion)
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-HAV with dislocation
-limitus/rigidus -polio, CP, previous joint surgery |
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trethowan
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OBWO for HAV
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Reverdin
Reverdin Green Reverdin Laird Reverdin G-L-Todd |
Reverdin - medially based wedge with the proximal cut perpendicular to long axis and distal cut paralell to srticular cartilage
RG - exits in L shape to protect sesamoids RL - RG with lateral shift of capital fragment (corrects Mod HAV, rather then mild of RG) RGLT - allows for PF of head, wedge removed from top and side of distal met |
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what can Reverdin Green Laird Todd be used for
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hallux limitus and HAV to PF the head
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valenti procedure and indications
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-dorsal "V" from 1st met and proximal phalanx to inc ROM and stop jamming
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baker procedure for achilles
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-achilles lengthening procedure
-tongue on Bottom, facing up |
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Achilles tendon rupture repairs
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Lindholm - two flaps from proximal achilles flapped downward
Lynn- end to end |
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achilles lengthening procedures
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-Baker (tongue)
-Silverskiold (detach gastroc above knee) -sliding Z |
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gastroc equinus treatment
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-strayer; distal transverse gastroc cut
-vulpius; V cut of gastroc, dont sew the retracted prox part to soleus like the strayer |
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Cotton procedure
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- procedure for pes planus and PTTD
-opening medial cuneiform osteotomy |
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Dwyer
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-closing medial wedge of calc to produce varus
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Hoke
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-arthrodesis of nave and cuneiforms for flat foot
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Brostrum - Gould (or just Brostrum)
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-direct repair of ATFL anf CFL
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Christman and Snook
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-use PL or PB to REINFORCE the ATFL and CFL
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