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115 Cards in this Set
- Front
- Back
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What are the common cause of recurrence following a phenol/alcohol procedure
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Common cause of recurrence include "old" or expired phenol, insuffient phenol application to affect areas; removing insufficent toenail border; inadequate hemostasis
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"granuloma" pygenicum" refers to?
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granulation tissue inj the medial or lateral nail groove.
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Where is the hyponychium anatomically?
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lies under the free margin of the naiil bed.
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how does an exostoses differ from osteochondroma?
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fibrocartilage caps the bone instead of ahyline cpa
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Teh advantages of the frost procedure include?
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maximum exposure to the nail matrix area
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What are the common digital blocks utilized for anesthesia pror to a surgical nail procdure?
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Two-point block, H-block, and hte unilateral block of steinberg
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effective intial treatment for an infected infgrown toenail border is ?
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partial nail avulsoon, PO antibiotic therapy, foot soaks
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Thsi patient above was effectively treated at first then returned six months later with pain secondary to incurvatio n of the nail fold in the absecne of erythema, edema, and purulence, what procedure is recommended?
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patial nail avulsion with matrixectomy.
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What is the proper sequence of the steps ussed during hte sequential reducton of a dorsally subluxed MPJ?
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release of extgensor hood expansion, release of collateral ligaments, relase of plantar joint tissues.
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What are the advantages i nthe use of the flexor tendon transfer for digital surgery?
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possible prevention of ajoingt fusion; decreased incidence of mallet toe; realignment of hte metatarsophalnageal jont
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What is a more common reported disasdvantage of the flexor tendon transfer in digital surgery?
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prolonged edema and stiffness.
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Given severe osteomyelitc destrucctio of a distal phalanx secondary to an ulcerated distal helma, what procedure would be indicated?
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distal symes amputation.
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What is the hoffman procedure?
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resection of mettarsal heads 1-5
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What is a more common reported disasdvantage of the flexor tendon transfer in digital surgery?
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prolonged edema and stiffness.
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What is an advantage of the plantar transvrse incisional approach for hte reumatoid forefoot reconstructoion?
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the plantar approach provides good expsure to eht severely damaged plangtarflexed metatarsal head
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What is the hood apparatus
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the hood apparatus or extensor expansion is the medial and lateral fibrous extensions of the extensor tendon. IT is composed of tendinous contributions from the long and short extensor tendosn as well fromj the lumbricales and interossei. The hood apparatus functions uch that the pull of the long ashort extensor tendos cretes dorsiflexionj of the proximal phalnx at the metarsophalangeal joint via the "sling" portion of the apparatus
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Given severe osteomyelitc destrucctio of a distal phalanx secondary to an ulcerated distal helma, what procedure would be indicated?
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distal symes amputation.
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What is the hoffman procedure?
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resection of mettarsal heads 1-5
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What is an advantage of the plantar transvrse incisional approach for hte reumatoid forefoot reconstructoion?
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the plantar approach provides good expsure to eht severely damaged plangtarflexed metatarsal head
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What is the hood apparatus
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the hood apparatus or extensor expansion is the medial and lateral fibrous extensions of the extensor tendon. IT is composed of tendinous contributions from the long and short extensor tendosn as well fromj the lumbricales and interossei. The hood apparatus functions uch that the pull of the long ashort extensor tendos cretes dorsiflexionj of the proximal phalnx at the metarsophalangeal joint via the "sling" portion of the apparatus
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How mnay interossei muscles are there and where do they insert?
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Three plantar interossei which insert on the base of the proximal phalnx, medially and four dorsal interossei which inset onthe base of the proximal phalnx laterally except he first dorsal interossei which inserts from medially. Together with the flexor digit quint brevis there are eight intgrinsic muscles htat function as a pair for each lesser digit.
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Whatar ethe forces and functions of the interossei muscles?
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the pull of the interossei muscles nerutralizes the force of the flexor muslces at the mtph
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describe the externosr substitution phenomen as an etiology for hammertoes?
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extensor substituion occcurs during proulsion, swing phase and heel contac twhen the xtensor digitorum longus and brevis muscles are active. It may occur as a result of an equinus and an anterior cavus foot type and mya manifest a s a result of perpheral neuropathy, as the intrisic muscles are often affect first.
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What are the benefits of compressive, post operative forefoot bandage?
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reduction of edema, maintian positioning as healing occurs, and diminhed risk of infection.
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What is the most common etiology of the heloma molle
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thypically the haed fo th proximal phalnx fo the fifth digit si dispace agaisnt the lateral condyld fo the base of the 4th proximal phalnx. the 4th toe may be long or shrter than customary altering the nrmel covex to concave relationship between toes
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Describe the pathology and corretion of brachmetarsia
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the toe is usually straght, but in an extended postion, and floats above the weight bearing plane. A deep sulcus is present benath the short metatarsal. Surgical streatment usually is directed toward lenghtening the shortened metarsa, often lenghtening extensor tendons as well.
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What are the disadvantages of the flexor tenotomy and capsulotomy?
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decrease in digital purchase postoperatively, high rate of recurrence of deformity and limite application.
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What may be considered the major cause for the recurrence of a hamered digit following digital surgery?
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instability at the mpj
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what is the relationship between the deep transvers intermetatrsal ligament (DTIL) and the interossei and lumbricales?
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the planter and dorsal interossei lie dorsally and the lumbricales plantarly
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What is the primary cause of flexor stabilization?
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excessive pronation cuaseing instability
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Overpowering of or by the flexor digitorum longus muscle will result in what deformity?
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dorsiflexion fo the MPJ and platarflexion of the PIPJ and DIPJ
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To develop the classic hammertoe the pull of which tendons are needed
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Both the FDL and FDB are needed
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The PIPJ arthrodesis effectively?
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converts the toe to a rigid lever on which the long flexor and extensor tendons can function effectively
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What ar the indications for an extnesor tneotomyh procedure?
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indicated in a flexible extensor hammerote but may also effectively be used as an adjunct to the digital arthroplasty
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at what level should and extnesor tenotmy procedure be perfomed?
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proximal to the extnesor hood apparatus
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What are the results of a flexor tnedon trnasfer?
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functions like the PIPJ arthrodesis remves a dynamic deforming force and stabilized the MPJ in plantarflexion
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What are the advantages of the peg in hole arthrodesis
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increased bone to bone contact increasing the fursion rate. No fixation is actually required. shortening of an elongated toe
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what plane may be involved indislcationof a metarsophalngealjoint
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All of them, duh (sagittal, transverse, and frontal)
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What is the 4th 5th intermetarsal angle that is gernally consedred symptomatic and elevated?
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9 degrees or higher
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What does lateral deviation angle mesaure?
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it measures structural deformit of the fifth metarsal intself
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What is a logical stepwise approach to the sevely overlapping fifth toe
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resction fo the head of proximal phalnx, lenghthening the extnsor digitorum longus tnedon, dorsal and medial capsulotmy, relase of the plantar plate nad removal of a plantar skin wdge. K-wire stabislsation may also be required.
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Describe the Hibs procedure
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the extensor digiorum longus tendons are dtached istally and tendesed into the midfoor, at he levle of the third metarsal bse.
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What is th emost commony chronically dilcated jmint in the foot?
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2nd MPJ
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Whic antomical structure i generally conseidered the most significant factor in sht stabilization of the MTPJ |
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plantar plate |
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What is the most common site ofr osteomyelitis folowing punctue wound to the foot?
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the calcaneus
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What is the most cmmon object to cause a puncture wound?
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Naisl (98%) also wood, metal, glass
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What are some possible complications of puncture wounds?
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soft tissue infection, osteomyelitis, foreign body granuloma, premature ephiphyseal clsur, joint degeneration and residual deformity.
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how often is cellulitis seen in a puncture wound?
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8.4% of pts seen in 24 hrs, 57% if seen 1-7 days
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What ar the tree classes of pseudomaons infeciton in cheldren described by green and Bruno
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Type I - early diagnosis and surgical drainage with antibiotic coverage results in complete healing
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What are th egoal f punctue wound treatment?
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comversion of contaminated woulnd ot a clean wound aprevention tentanus.
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tetanus prphyylaxi is bassed on what four components?
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wound care, tetanus toxoid, immune glubulin, nad antibiotic
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How oftten should tetanus boosters be administered?
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for patients with an indeterminate number of toxid injections, last injection ws greater tahn one year nad wound itenus prone, administer the booster. If wound is non-tetanus prone a boster shold be adminsitered at intervals of five years.
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what is the most commony encountered foreing body in the foot?
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A pin or needle.
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What are some possible complications of animal bites?
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cellulitis, lymphangitis, abscesses, OM, subcutanteous gas, mengingitsi, endocartitis, tularemia, syphilis.
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necrotic arahnidism is senin in what type of bit?
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brown recluse spider (loxosceles) , sever necrotic tissue destruction, blu gray halo progesses to necros eschar formation and a larrgeulceration.
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treatment for brown recluse spider biets?
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controversial , but intarlesioan and oral steroids, surgical debridement, and dapsone
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Wwhat is the difference between a low velocity and a high velocity projectile?
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low velocity <or = 200f /second
hig velocy > 2000 ft/second |
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What formula describes the amount of energy possesed by a prjectile
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KE = a/2 mv^2
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Describe the classification for shotgun wounds and name its develpers.
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Sherman and Parrish
Type I - penetrate subcutaneous tissue or deep fascia, > 7 yards Type II- 3-7 yards visera, bones and vascular system violated Typpe III - < 3 yards, severe loca destruction ad loss of of tissue |
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Describe Ordog's classifcation for gunshot wounds.
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type 0 - no injury
type I - blunt injury (nonpnetrating gunshot wound) type ii - graze injury (abrasion, injury to epidermis, superficail dermis) tyep iii - blast effect without missiole pentration type IV - blast effect with missile pnetration type v - pentrating A - laceration through dermis, B- subcutaneous C- all deep structues, D - body cavity, E- more tan one body region. VI - perforating - abcd or e vii - pentration with misslle emblization. |
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what ar ethe basic tenants for simple lwo velcity misslile wound care?
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adequate nonoperative stabilization of fractures
adequate debridement of expose necrotic tissue clansing of the owund with irrigation clsure without tension wound obsrvation for 48-72 hours |
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what are the basic tenants for complex low velcity missile osund care
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cleansing with antseptics/ jet lavage
open reduction of fracture sites utilizing internal/external vixation intravenous broad spectrrum antibiotics daily wound observation and care until clincally injinfected and viable prmary versu delayed prmary versu secndary clusre |
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gernally low velocity gunshot wounds are considered what type in gustilo's classification?
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Type I
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What is lead intoxiation called?
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plumbism
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Describe Ordog's classifcation for gunshot wounds.
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type 0 - no injury
type I - blunt injury (nonpnetrating gunshot wound) type ii - graze injury (abrasion, injury to epidermis, superficail dermis) tyep iii - blast effect without missiole pentration type IV - blast effect with missile pnetration type v - pentrating A - laceration through dermis, B- subcutaneous C- all deep structues, D - body cavity, E- more tan one body region. VI - perforating - abcd or e vii - pentration with misslle emblization. |
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what ar ethe basic tenants for simple lwo velcity misslile wound care?
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adequate nonoperative stabilization of fractures
adequate debridement of expose necrotic tissue clansing of the owund with irrigation clsure without tension wound obsrvation for 48-72 hours |
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what are the basic tenants for complex low velcity missile osund care
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cleansing with antseptics/ jet lavage
open reduction of fracture sites utilizing internal/external vixation intravenous broad spectrrum antibiotics daily wound observation and care until clincally injinfected and viable prmary versu delayed prmary versu secndary clusre |
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gernally low velocity gunshot wounds are considered what type in gustilo's classification?
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Type I
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What is lead intoxiation called?
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plumbism
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What is the antibiotic of choice for type I gunshot wounds?
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cephalosporin
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Is "cavitation" assocated with low or high velocity gunshot wounds?
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high velocity
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What ar e the factorrs with determine the size and extent of damge procude by a projectile?
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tye type of tissue the prjectile penetrates, the bullets' compsition, the bulloe tor boen framentation creating secondary missile, and the amount of energy that hte projectiledissipate in the tissue
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What tis the largest oran in the body?
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the inegumentary system is th largest organ in the body, comprising 15% of hte toal body weight.
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WHAT IS LACHMAN TEST
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WITHTHE SECON METARTSALIMMOBILEZED AND PROXIMAL PHALNX HELD IN 20 TO 25 DEGREES OF DORSIFLEXION, THE ORXOMLA PHALNX IS TRANSLATED VERTICLALLY IN A DORSAL DIRECTION. tHIS A TEST FOR mpj INSTABILTY OR THE ABILITY T O RESIT DORSAL SUBLUXATION
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wHAT STUDIES ARE TRADITIONALLY USED TO ASSES INSTABILTY AT HTE SECOND MDTARSOPHALANGEAL JOINT?
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PLAN RADIOGRAPHS A, mri AND ARHTROGRAPHNY.
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What is the pahtophyisology of an tintermetarsal neruoma?
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perineural fibrosis
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What is the epidemialogy fo the intermatearsal neruoma
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femae predominace,unusual in person hyounger than 18 years old, it imost common for a atient o ahve a single neuroma rather than multiple ones and most often found int eh second or therid interespces.
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the intertataral neuroma most often involves whcih nerve?
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third common digital brfanch of the medial plantar nerve.
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What is an uncommon finding when re-operating of mortons' neuroma
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inordinagtte scar tissue isuaually not sen. an amputation neuoam oar an intact accessory nerve trunk distal to the DTIL is eeen as well as the DTIIL (deep trnasver itnermetatral ligament) whcih has reapproximated itself.
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What anaotmical structue(s) is cited s enterapping the intermetaral nerve?
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the deep tranverse intermetarsal ligament
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What are the specific complications assocated iwth surgical exciaion of the neruoma?
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stujp neurooma, vascualr embarrassment, and dital and/or MPJ mechnaica instability
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Joplin' neuroma involves whcih anatomica structue?
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Plantar proper digital nerve.
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Common cause of this entrapment neruopathy know as Joplin's neuroma inclue: Sporting activiets such as running, soccer, basketball, snow skiing , that involve pivoting impact and motion surroundng the fisr metarsophalnea jojntn.
Chonic compression form a tight shoe. A prominent medial epicondy of hte fir metatsal |
The nuroma know as Iselin's neuroma is found in the 1st interspace.
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Heuter's nuroma is found in?
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in the 4th interspace.
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The relaxed skin tension lines in the sub-metarsal head reion or plantar forefoot run:
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paralel to the plantear threanverse lines alongthe lesser digits.
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The incisiona planning o f aderotation arthropst of the 5th digit includes;
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The incisiona planning of a derotation arthropalst of the 5th digit inludes: 2 seim-elliptical incison coursing form proximal laterla to distal mdial
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What is Feiberg's infraction
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Ostoechondrosis of the metatrsal head most commonlyh the second, appearingmost often in the second deacde of life.
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What is cmmon etiology of an epiderma inclusion cyst?
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it may follow a surgical procedure in which epeiderm is introduce subepidermally, forming and intraderma foregn body tha tcasue pain and inlamation
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What is an uncommon finding when re-operating of mortons' neuroma
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inordinagtte scar tissue isuaually not sen. an amputation neuoam oar an intact accessory nerve trunk distal to the DTIL is eeen as well as the DTIIL (deep trnasver itnermetatral ligament) whcih has reapproximated itself.
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What anaotmical structue(s) is cited s enterapping the intermetaral nerve?
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the deep tranverse intermetarsal ligament
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What are the specific complications assocated iwth surgical exciaion of the neruoma?
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stujp neurooma, vascualr embarrassment, and dital and/or MPJ mechnaica instability
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Joplin' neuroma involves whcih anatomica structue?
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Plantar proper digital nerve.
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What is an uncommon finding when re-operating of mortons' neuroma
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inordinagtte scar tissue isuaually not sen. an amputation neuoam oar an intact accessory nerve trunk distal to the DTIL is eeen as well as the DTIIL (deep trnasver itnermetatral ligament) whcih has reapproximated itself.
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Common cause of this entrapment neruopathy know as Joplin's neuroma inclue: Sporting activiets such as running, soccer, basketball, snow skiing , that involve pivoting impact and motion surroundng the fisr metarsophalnea jojntn.
Chonic compression form a tight shoe. A prominent medial epicondy of hte fir metatsal |
The nuroma know as Iselin's neuroma is found in the 1st interspace.
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What anaotmical structue(s) is cited s enterapping the intermetaral nerve?
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the deep tranverse intermetarsal ligament
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Heuter's nuroma is found in?
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in the 4th interspace.
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What are the specific complications assocated iwth surgical exciaion of the neruoma?
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stujp neurooma, vascualr embarrassment, and dital and/or MPJ mechnaica instability
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The relaxed skin tension lines in the sub-metarsal head reion or plantar forefoot run:
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paralel to the plantear threanverse lines alongthe lesser digits.
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Joplin' neuroma involves whcih anatomica structue?
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Plantar proper digital nerve.
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The incisiona planning o f aderotation arthropst of the 5th digit includes;
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The incisiona planning of a derotation arthropalst of the 5th digit inludes: 2 seim-elliptical incison coursing form proximal laterla to distal mdial
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Common cause of this entrapment neruopathy know as Joplin's neuroma inclue: Sporting activiets such as running, soccer, basketball, snow skiing , that involve pivoting impact and motion surroundng the fisr metarsophalnea jojntn.
Chonic compression form a tight shoe. A prominent medial epicondy of hte fir metatsal |
The nuroma know as Iselin's neuroma is found in the 1st interspace.
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What is Feiberg's infraction
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Ostoechondrosis of the metatrsal head most commonlyh the second, appearingmost often in the second deacde of life.
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Heuter's nuroma is found in?
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in the 4th interspace.
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What is cmmon etiology of an epiderma inclusion cyst?
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it may follow a surgical procedure in which epeiderm is introduce subepidermally, forming and intraderma foregn body tha tcasue pain and inlamation
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The relaxed skin tension lines in the sub-metarsal head reion or plantar forefoot run:
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paralel to the plantear threanverse lines alongthe lesser digits.
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The incisiona planning o f aderotation arthropst of the 5th digit includes;
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The incisiona planning of a derotation arthropalst of the 5th digit inludes: 2 seim-elliptical incison coursing form proximal laterla to distal mdial
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What is Feiberg's infraction
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Ostoechondrosis of the metatrsal head most commonlyh the second, appearingmost often in the second deacde of life.
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What is cmmon etiology of an epiderma inclusion cyst?
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it may follow a surgical procedure in which epeiderm is introduce subepidermally, forming and intraderma foregn body tha tcasue pain and inlamation
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Which of the following desribes a benign longitudinal unual pimentation?
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longtiudinal mealnoychia
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A l longitudinal ungual pigmentation in a fair skinned indivuiual wihout any precursor or injury should indicate:
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possible precursor of acral lentigionous melanoma and hteneed for nail avulsion and bipsy
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What is the etilogy of keloies?
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represent fibrous ractions at surgery or injury sites. Teh reaction ivolves myofibroblast ans my be related ot abnormaities of capillary endotheilum durign granulation Kelids may be assciated with fibromatoes and with petic ulcers and ensotoese
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Does infantile digital fibramamotsisrequeir tratment?
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the lesions occur in fingera nd toes and may regrees sponateously or requrie surgical excsion.
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Do digtial mucous cyst communicate with the joints?
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Yes they may communicate withthe distal interphalangeal jont and will often recur with local curttage.
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The clnical presnationf a child with shortend digits and hallux valgus may signivy
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myositis ossificans prgessiva
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A slitiary , subungaul, reddish-purple painfu lseion may be a ?
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glomsus tumor.
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