Pod Surgery Ii Exam 2

Front 1

what are the stages and guidelines for excisions of tumors?

Back 1

Guidelines of Excision
Stage 1 (Benign, latent)
Intracapsular Excision
Marginal Local Excision
Diagnosis must be certain

Guidelines of Excision
Stage 2 (Benign, Active)
Marginal Local Excision
Careful Dissection
30% recurrence with intracapsular excision

Guidelines of Excision
Stage 3 (Benign, Aggressive)
Wide local Excision
Extracapsular satellite lesions
50% recurrence with marginal excision

Guidelines of Excision
Stage 1A (Malignant, Low-Grade, Intracompartmental)
Wide Marginal Resection
Low recurrence rate

Stage 1B (Malignant, Low-Grade, Extracompartmental)
Recurrence increased

Guidelines of Excision
Stage IIA & IIB (Malignant, high-grade, Intra/Extracompartmental)
Radical Margin Excision

Front 2

Benign lesion
Younger individuals
Well circumscribed
Thin walled, amber fluid filled
Freely movable
May impinge on anatomic neighbors
Excision, high recurrence rate

Back 2

Ganglion cyst

(Attachment:
Extensor Tendon
Joint Capsule)

Front 3

Most common plantar foot lesion

Back 3

Plantar fibroma

Front 4

20 – 40 y/o
10 – 15% Bilateral
Plantar Zig-Zag incision
High recurrence
Pain with compression and weight bearing

Back 4

Plantar fibroma

Front 5

Most common soft tissue tumor

Back 5

Lipoma

Front 6

Active, benign Stage 2 lesions
Peripheral nerve spindle cell origin

Back 6

Neurofibroma

Front 7

Benign
Arising from peripheral nerve sheath
Fusiform, well-encapsulated nodule

Back 7

Neurolemoma

(Discrete, often tender nodule
Neurogenic pain and paresthesias
Slow growth
Seldom >2cm in diameter
Stage 2, Active : Stage 1, latent
Marginal local excision)

Front 8

Benign tumors of blood vessels
Childhood or early adolescence
Skin and subcutaneous tissues
More common
Painless mass
Bluish color
Soft, easily compressable
Deep fascia and muscle
Rare
Intermittent pain
*Blanchable w compression
PAINLESS

Back 8

Capillary Hemangioma (most common form)

(vs Cavernous hemangioma)

Front 9

Large, dilated, tourtuous endothelial cavities
Appear bluish
PAINFUL
*Do not blanch with compression

Back 9

Cavernous Hemangioma

(vs capillary hemangioma)

Front 10

Benign
Aggressive, proliferative lesion of synoval membranes
Microscopical eval
Fibroblast
Giant cells

Back 10

Pigmented Villonodular Synovitis

(3 types:
Extraarticular tenosynovial giant cell tumor
Solitary intraarticular nodules
Diffuse, villous, pigmented involving synovial membrane of joint)

Front 11

Painful
Swelling and limitation of joint motion
Joint aspirate
Serosanguinous brownish fluid
Underlying osseous changes on x-ray

Back 11

Pigmented Villonodular Synovitis

Front 12

Benign
Smooth muscle layer of blood cell origin
Female:male, 2:1
Solitary, encapsulated
Freely moveable
Recurrence is low

Back 12

Angioleiomyoma

"Angio is low (recurrence)"

Front 13

Which tumor?
Common on plantar foot
keratin is produced
Forms mass
**“cheesy material”
Sinus tract may develop
Painful

Back 13

Epidermal inclusion cyst

(caused from traumatic introduction of epidermal cells into the subepidermal layer)

Front 14

Most common malignant ST tumor?

Back 14

Malignant Fibrous Histiocytoma
(Most common malignant ST tumor
5 subtypes:
Pleomorphic
Myxoid
Giant cell
Inflammatory
Angiomatoid)

"FIbrous has FIve subtypes: i AM PIG"

Front 15

50-70 y/o
Angiomatoid – adolescence
Males > females
Pain, fever,chills, and myalgia
Located below the deep fascia
5 year survival 73% when lesion located distal to the knee (28% proximal)

Back 15

Malignant Fibrous Histiocytoma

Front 16

70% in the lower extremity
< 50% occur close to a joint
Fewer in direct continuity with joint synovium
Slow growing
High-rage lesion
Minimal exposure biopsy
Radical resection or amputation is required

Back 16

Synovial sarcoma

Front 17

Malignant tumor
Rare in foot and ankle
Arises from deep fascia
Men > 40y/o
Symes amputation with distal small lesions
Otherwise BKA is reccommended

Back 17

Fibrosarcoma

Front 18

Malignant
40 to 60 y/o
Male > females
Nonencapsulated, invasive growth
*Metastasis is common
Staged differentiation
Radical excision or amputation

Back 18

Liposarcoma

Front 19

Which implant is put in by cutting a window in the tibia?

Back 19

Buechel pappas

Front 20

Which implant has a dual fin talar fixation?

Back 20

Buechel pappas

Front 21

What is the only implant you can do with AVN?

Back 21

Buechel pappas

Front 22

Which implant fuses the tibia and fibular and has a definitive amputation rate?

Back 22

Alvin agility

Front 23

your choices are Alvin agility and STAR implant:
which is mobile bearing and which is rigid/fixed?

Back 23

Alvin agility is rigid/fixed.

STAR is mobile bearing

Front 24

Which implant has a rounded talor component so that it moves 360 degrees?

Back 24

Ramses

"Ramses is Round"

Front 25

Only implant that goes into lateral side?

Back 25

ESKA implant

"Esculate---->ESKA-LATe"

Front 26

Which 2 popular implants can NOT be used for talar necrosis?

Back 26

STAR and ALvin

“AVasculAR necrosis---can’t use AlVin and stAR”

Front 27

Which implant:
Cobalt-Chromium Alloy double stem tibial component
Ultra-High Molecular Weight Polyethylene meniscus
Hydroxyapatite tibial-talar coating

Back 27

STAR

Front 28

Which implant:
Titanium alloy single stem tibial prosthesis
Ultracoat Titanium Nitride beaded coating
Dual fin talar fixation
Meniscus of Ultra-High Molecular Weight Polyethylene

Back 28

Buechel-Pappas

Front 29

Which implant uses a sulcus burr for the talar sulcus step?

Back 29

Buechel-pappas

Front 30

How many current total ankle joint prostheses are in use around the world?

Back 30

11

(from Feldman article)
Agility (DuPuy, Warsaw, IN)
Scandinavian Total Ankle Replacement (Waldmar Link, Hamburg, Germany)
Buechel-Pappas (Endotec, Orange, NJ)
Salto (Tornier SA, Lyon, France)
Alpha OSG (Alphanorm, Quiershied, Germany)
Ankle Evolutive System (AES) (Biomet Merck France Sarl (French Corporation),
Valence, France)
ESKA (ESKA, Lubeck, Germany)
Albatros, (Groupe Lepine, Lyon, France)
Hintegra (Newdeal SA, Lyon, France)
Ramses (Fournitures Hospitalie`res Industrie, Quimper, France)
TNK ceramic ankle prosthesis (Dr. Yoshino Takakura, Nara, Japan).

Front 31

Which implant is the only total titanium and titanium nitride implant?

Back 31

Buechel Pappas

Front 32

Which implant:
"It is the
only one that requires excision of 40% to 50% of the width of both malleoli,
excision and fusion of the tibio-fibular syndesmosis, and fixation of the fibula/
tibia with transcortical screws. It requires the excision of more dome of the talus
than any other prosthesis. It is the most difficult of the seven ankles the author has
experience with to implant and is the only one requiring that an external ankle
joint distractor be used for the procedure."

Back 32

Agility

Front 33

Which implant?
"The implant is classified by the FDA as a class II prosthesis, thus allowing
it to be the only FDA-approved ankle implant in the United States at this
time."

Back 33

Agility

Front 34

Which implant?
"...is the only design
with a separate specific talar avascular necrosis (AVN) component, called the
THICK talus."

Back 34

Buechel Pappas

Front 35

According to Feldman article: "Who are the patients for whom TAA offers an advantage
over fusion?"

Back 35

"The brief answer is the middle aged or elderly
patient with an anatomically aligned ankle and heel, whose
ankle has a well-preserved range of movement that includes
at least 5 degrees of dorsiflexion."

Front 36

True of false:
Mitchell introduced term “phantom limb” & he describes what we call CRPS today
Dekatas first used the term “reflex sympathetic dystrophy”

Back 36

True
(from handout)

Front 37

Best diagnostic test for CRPS?

Back 37

Bone scan

(Bone scan uptake in areas beyond initial trauma)

Front 38

Whats going on here and what is it indicative of?

Back 38

The bone appears mottled “ = describing punched out lesions due to periarticular remodeling seen in CRPS---->SUDECKS ATROPHY!

Front 39

Describe the clinical phases of CRPS (one word description for each phase)

Back 39

Phase IA=Vasoconstriction (2-6 WEEKS)

Phase IB=Vasodilatation (2-6 MONTHS)

Phase II=Osteoporosis (6-12 MONTHS)

Phase III=Vasoconstriction

Front 40

Which phase of CRPS do you see sudeck's atrophy as the hallmark sign?

Back 40

Phase II

"SUe is TWO"

Front 41

Which phase of CRPS do you see cyanotic nail beds?

Back 41

Phase IA

Front 42

Which phase of CRPS do you see "doughy edema"?

Back 42

Phase IB

Front 43

Which phase of CRPS do you see morbid, constricted muscle atrophy?

Back 43

Phase III

Front 44

Dose of oral steroids for CRPS at:
week 1?
week 2?
week 3?
week 4?
week 5?

Back 44

week 1=40-60mg/day
2=30-50mg
3=20-40mg
4=10-30mg
5=0-10mg

Front 45

what is the technique called that uses an epidermal block for CRPS?

Back 45

Raj technique

Front 46

why would one use a "sham block" in CRPS?

Back 46

it is an injection of normal saline to rule out malingering

Front 47

what is the average number of sympathetic blocks used in treatment of CRPS? what is the success rate?

Back 47

3-4

80%

Front 48

which 2 treatments for CRPS are vasodilators and used for HTN as well?

Back 48

Reserpine and guanethidine monosulfate (Ismelin)

Front 49

which treatment for CRPS is used for ventricular fibrillations as well?

Back 49

bretylium tosylate (Bretylol, Darenthin)

Front 50

which treatment for CRPS is a tricyclic antidepressant?

Back 50

Elavil (amitriptyline)
(50-75mg hs or divided, max daily dose 150mg)

"Elavates your mood"

Front 51

Which treatment for CRPS is used for pheochromocytoma to control episodes of HTN and sweating?

Back 51

Phenoxybenzamine HCL (Dibenzyline)

"PHENO for PHEO"

Front 52

Which treatment for CRPS is used for persistant pulmonary HTN of the newborn

Back 52

Tolazoline HCL (Priscoline)

Front 53

True of false:
Methodone and Nyquil are good for pain control for CRPS

Back 53

True

Front 54

In terms of external fixation and bone marrow lesion prognosis, if the two shafts of bone overlap competely, how many days prognosis?

Back 54

21-30 days

Front 55

In terms of external fixation and bone marrow lesion prognosis, if the center of the midshaft are seperated by more than half but still some medullary canal closer to next, how many days prognosis?

Back 55

41-50 days

Front 56

In terms of external fixation and bone marrow lesion prognosis, if the center of the midshaft is seperated by less than half but not completely overlapping, how many days prognosis?

Back 56

31-40 days

Front 57

In terms of external fixation and bone marrow lesion prognosis, if the two shafts of bone are completely seperated and not touching, how many days prognosis?

Back 57

51-70 days

Front 58

In terms of the mechanism of injury requiring an external fixator, if you have direct trauma, a 5cm or less open lesion, or a large smash /degloving injury.......then you add an additional __?__ weeks per mechanism to the marrow prognosis.

Back 58

2

Front 59

External fixation:
With distal traction joints and the ligamentous attachments are stretched. Safe time is ______ hours with _____kg traction. Joints affected if stretched longer. Most efficient to distract immediately adjacent to the fracture site. This may be adjacent bone if spanning joint.

Back 59

With distal traction joints and the ligamentous attachments are stretched. Safe time is <2-3 hours with ~6 kg traction. Joints affected if stretched longer. Most efficient to distract immediately adjacent to the fracture site. This may be adjacent bone if spanning joint.

Front 60

When external fixation is placed, when does patient start PT with partial weightbaring?
When do they start FWB or with a cane?

Back 60

the next day

one month

(walking is impt because the muscles pull fracture into compression)

Front 61

External fixation:
When you get purulent drainage, on day one treat infection with ABX and cleaning!! Daily with antiseptic. In _______ days if still pus, pull the wire and I&D sight with lavage and IM ABX best, PO ok.
If this occurs later in treatment you may not need to reapply wires, but if you need to reapply then reinsert in 4-5days.

Back 61

When you get purulent drainage, on day one treat infection with ABX and cleaning!! Daily with antiseptic. In 2-3 days if still pus, pull the wire and I&D sight with lavage and IM ABX best, PO ok.
If this occurs later in treatment you may not need to reapply wires, but if you need to reapply then reinsert in 4-5days.
If wire is painful for several days post op, reposition on the ring. Possible nerve irritation.

Front 62

True/False?
External fixation:
If wire is painful for several days post op, the wire needs to be taken out.

Back 62

FALSE
If wire is painful for several days post op, reposition on the ring. Possible nerve irritation.

Front 63

There are 4 types of pseudoarthrosis described, which one describes the following:
the fragment ends are atrophic, sharpen end, periosteal layers are absent, and marrow canal is dysfunctional (poor vascular supply). 20 deg motion. Unable to lengthen through closed technique due to poor regenerate potential.

Back 63

hypoplastic

Front 64

There are 4 types of pseudoarthrosis described, which one describes the following:
ends are more congruent, mild-mod osteoporosis, sclerotic ends, good vascular status.10-15 deg mobility

Back 64

Normoplastic

Front 65

There are 4 types of pseudoarthrosis described, which one describes the following:
fragment ends are thickened (bamboo-like), marked collateral circulation. 5-7 deg mobility

Back 65

Hyperplastic

Front 66

There are 4 types of pseudoarthrosis described, which one describes the following:
fragment ends are smooth, ball and socket like, capsule, canal is closed with bone (with large defect), hypervascular soft tissue.

Back 66

Nearthrosis

Front 67

External fixation powerpoint:
1) How many mm per day can lengthen bone?
2) What dye is used in resecting bone for osteomyelitis?

Back 67

1) 0.75mm/day
2) Methyl blue (i think he meant to say methylene blue)

Front 68

According to the student presentation, which implant was the first to be approved by the FDA?

The ankle joint is classified as what kind of joint?

Back 68

Agility

Hinge joint


(-from treu dang and fadi presentation)

Front 69

According to the student presentation for external fixation, what was the only pre req listed in the study?

How long was the cast left on? how long was frame left on?

Back 69

Adequate blood supply

Cast left on for 3 months, frame for 4 months

8% bka, 8% had chronic vascular

I dont know what any of this really means but its what i have for Azukes presentation.

Front 70

according to student presentation, for the stable tibial component how many rods, how many rings, and how many wires are used?

Back 70

2 rings, 2 rods, 4-6 wires: stable tibial component.

???

Front 71

True or false:
Although everyone is taught to take a thorough history and physical before the clinical examination, in the context of soft tissue masses this information is commonly not helpful in the differentiation or categorization of the mass. Similarly, the epidemiological information such as age, sex, and race among others is of little concrete use.

Back 71

True

Front 72

What is probably the most important diagnostic tool for characterization and gross classification of the soft tissue mass?

Back 72

Physical examination

Front 73

The most specific and sensitive study for imaging soft tissue masses is __________.

Back 73

MRI

Front 74

What is the primary goal of a biopsy of a tumor/lesion?

Back 74

Diagnosis

Front 75

True or false:
When planning an incisional biopsy, it is most important to orient the incision in a transverse fashion or in other words, perpendicular to the muscle beneath it.

Back 75

FALSE
When planning an incisional biopsy, it is most important to orient the incision in a longitudinal fashion or in other words, parallel to the muscle beneath it. In case the lesion is malignant, the longitudinal incisional scar can easily be excised at the next operation. Yet if erroneously fashioned or transversely fashioned, the incision tract will acquire a much wider excision that may compromise closure

Front 76

**Student presentation on CRPS:
In a patient with positive “Kick-Off” position, when the patient’s leg has been pushed down from its initial extended position and then the patient is distracted, the leg will ________________________________________.

Back 76

Involuntarily return to the initial extended position

Front 77

According to student presentation on CRPS:
1) What nerve is by far the most common nerve involved in CRPS type 2
2) How long after injury should u start to consider a DX of CRPS?
3) How long do u expect patient to have pain after bunion SX?

Back 77

1) Superficial peroneal nerve
2) Atleast 3 months
3) 4 months

Front 78

Random important info on earlier student presentations:
-Trisas presentation on charcot. What goal of the surgery was prob obtained but not really studied in this paper? Goal Was to redistribute weight on bottom of foot to prevent future ulceration so want to know foot shape & if they got subsequent ulcers
-26% pin tract infection rate in study.
-The limb salvage rate of the diabetic Charcot foot and ankle deformities in this study was 96%.

*Acute phase of charcot foot is about 2 WEEKS
*Coalescence phase is about 2 MONTHS
*Remodeling phase is about 2 YEARS

-Ring fixator-gonna leave on 10-12 weeks and according to this article, 1 of those 4 pins get infected!
-Average external fixator has 10 wires.
*12 wires 12 weeks! If you see one of these frames think of it as each wire last a week. 3 in FF 3 in RF and 3 in each tibial ring.

-Cliffs presentation.
81% recurrence rate after 2 years.
FDB flap for calcaneous

Back 78

none

Front 79

What is the most common ST malignancy of the FOOT?

Back 79

Synovial sarcoma