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101 Cards in this Set
- Front
- Back
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common causes of recurrence or failed phenol/alcohol nail procedures
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-old phenol
-insufficient phenol application -removal of insufficient nail border -inadequate hemostasis |
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granuloma pyogenicum refers to to
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-granulation tissue in the medial or lateral groove
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where is the hyponychium anatomically
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lie under the free margin of the nail bed
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how does an exostoses differ from an osteochondroma
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-fibrocartilage caps the bone instead of a hyaline cap
osteochondroma: cartilage capped outgrowth connected to the bone by a stalk |
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what is the Frost procedure and what is the advantage
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-maximum exposure to the nail matrix
L shaped incision behind the nail plate |
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what is the proper sequence of steps used during the sequential reduction of a dorsally subluxed MPJ
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-release the extensor hood expansion
-release the collaterals -release the plantar joint tissues |
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given severe OM destruction of a distal pahalnx secondary to an ulcerated distal heloma, what procedure would be indicated
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distal symes amp
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Hoffman procedure
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resection of met heads 1-5
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what is the advantage to a plantar transverse incisonal approach for RA forefoot procedures
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-good exposure to the severely PF met heads
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how many interossei are there nad where do they insert
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- 4 dorsal, 3 plantar
-DI insert base of proximal pahlanx laterally, xcept the 1st -PI insert base of proximally phalanx medially |
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what are the forces and functions of the interossei
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-the pull of the interosei neutralizes the force of the flexor muscles at the MPJ's
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Ext sub cause of HT's
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EDL overpowers the instrinsics
(equinus, anterior cavus, neuropathy) |
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common etiology of heloma molle
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-head of prox phalanx of 5th against the base of the 4th prox phalanx
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what is the relationship between the DTIL and the interossei and lumbricals
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the plantar and dorsal interossei lie dorsal and the lumbricals plantar
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what is the MC cause of flexor stabilzation
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excessive pronation causing instability
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to develop the classic HT, the pull of which tendons are needed
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FDL and FDB
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at what level should an extensor tenotomy be performed
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proximal to the ext hood apparatus
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4th IM angle that is considred symptomatic
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9 degrees
N = 6-8 N bowing = 2 (2-4-6) |
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Hibbs Procedure
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EDL tendons are detached and attached at the midfoot
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MC chronically dislocated joint in the foot
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-2n MPJ
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what anatomical structure is considered most sig nif facotr in stabilization of the MPJ
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plantar plate
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what is the pathophysiology of an IM neuroma
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-perineural fibrosis
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the IM neuroma most commonly invovles which nerve
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common digital branch of MPN
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what structure is cited as entrapping the IM nerve
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DTIL
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what are specific complications assoc with surgical excision of a neuroma
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-stump neuroma
-vascular embarassment -digital or MPJ instability |
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Joplins neuroma occurs in what nerve
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medial plantar digital nerve (plantar proper digital nerve)
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iselins neuroma
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4th interspace
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hueters neuroma
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1st interspace
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incisional planning for derotational arthroplasty of 5th digit
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2 semi elliptical incisions from prox lateral to distal medial
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epidermal inclusion cyst - etiology
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-may follow a surgical procedure in which the epidermis is introduced subepidermally forming an intradermal foreign body and causes pain and inflammation
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longitudinal ungual pigmentation in a fair skinned person
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precursor for acral lentiginous melanoma (avlulse and biopsy)
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etiology of keloids
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-fibrous reactions at injury sites
-reaction involves myofibroblasts |
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do digital mucoid cysts communicate with joints
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yes, communicate with distal IPJ and will often recur after curettage
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clinical presentation of a child with shortened digits and HAV may signify
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myositis ossificans progressiva
-tendons and ligaments are replaced by bone |
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a solitary, subungual, reddish purple pain lesions
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glomus tumor
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what is the name of the scarring nail dystrophy characteristic of lichen planus
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-pterygium formation
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Lovibonds angle is used to measure nail clubbing; explain
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-lovibonds lateral profile sign is used to measure clubbing and is defined as the angle between the curved nail plate and the proximal nail fold
-normal is 160, clubbing exceeds 180 |
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periungual fibromas or Koenens tumors are found in 50% of the cases of which disease
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tuberous sclerosis
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what diagnostic test is considered gold std for detecting a glomus tumor of the nail bed
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arteriography
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hutchinsons sign
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-brown to black discolration of the nail bed spreading to nail fold skin suggesting melanoma
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what poisoning can cause transverse lines in the nails
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arsenic - mee's lines
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what is the MC cause of isolated splinter hemorrhages of the nail bed
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trauma
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what specific form of onychomycosis is associated with HIV
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proximal subungual onychomycosis
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in onychomycosis how long should one wait to see the full therapeutic effect of a 3 month course of oral itraconazole or terbinafine
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ten months
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responsible for 90% of cases of onychomycosis
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trichophytum
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MC lab test for onychomycosis
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nail clip biopsy with PAS stain (periodic acid Schiff)
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what are shallow transverse grooves of the nail plate
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beaus lines
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patzakis classification for zones of plantar aspect of foot
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zone 1- digits to neck of mets
2 - area between the met necks and calcs 3 - calcaneus 1 and 3 are associated with increased incidence of OM from puncture wound |
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in a puncture wound with a retained foreign body, how long does it take for an infection to manifest
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24 hours
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why are structures such as instrinsic tendons, extrinsic tendons, IM bursa, and MPJ capsule of worry with puncture wounds
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-if puncture wounds extends to these structures , infection can be established easily due to their decreased vascularity and slower metabolic rate
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what type of imaging study is best for detecting wood fragments
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CT with use of narrow window
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when does OM become evident on xray, on bone scan?
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xray - 14 days
bone scan - 24 hours |
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gold std for OM diagnosis
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-bone biopsy
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puncture wounds from dog and cat bites, organism and tx
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-pasturella multocida
-augmentin |
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OM in a puncture wound bacteria
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-pseudomonas aeruginosa
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most common site for OM in puncture wound of the foot
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calcaneus
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MC object for foot puncture wound
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nail (98%)
-wood, metal, glass |
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3 classes of pseudomonas infection in children described by Green and Bruno
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1- early diagnosis and surgical drainage with abx coverage results in complete healing
2 - diagnosis delayed in 9-24 days. debridement and abx eradicate infection but pt may have residual bone or joint deformity 3 - diagnosis delayed over 3 weeks results in chronic infection with necessary bone resection |
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3 classes of pseudomonas infection in children described by Green and Bruno
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1- early diagnosis and surgical drainage with abx coverage results in complete healing
2 - diagnosis delayed in 9-24 days. debridement and abx eradicate infection but pt may have residual bone or joint deformity 3 - diagnosis delayed over 3 weeks results in chronic infection with necessary bone resection |
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tetanus prophylaxis consists of what 4 components
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-wound care
-tetanus toxoid -immune globulin -abx |
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how often should tetanus boosters be administered
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-when last injection was greater then 1 yr and the wound is tetanus prone; give the booster
-if the wound is not tetanus prone, booster should be given every 5 yrs |
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tetanus prophylaxis consists of what 4 components
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-wound care
-tetanus toxoid -immune globulin -abx |
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MC encountered foreign body in the foot
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pin or needle
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how often should tetanus boosters be administered
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-when last injection was greater then 1 yr and the wound is tetanus prone; give the booster
-if the wound is not tetanus prone, booster should be given every 5 yrs |
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MC encountered foreign body in the foot
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pin or needle
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necrotic arachnidism - clinical progression and cause
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-brown recluse of genus Loxosclese
-severe necrotic tissue destruction -blue gray halo peri wound -progresses to necrosis, eschar foration and large ulceration |
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necrotic arachnidism - clinical progression and cause
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-brown recluse of genus Loxosclese
-severe necrotic tissue destruction -blue gray halo peri wound -progresses to necrosis, eschar foration and large ulceration |
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3 classes of pseudomonas infection in children described by Green and Bruno
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1- early diagnosis and surgical drainage with abx coverage results in complete healing
2 - diagnosis delayed in 9-24 days. debridement and abx eradicate infection but pt may have residual bone or joint deformity 3 - diagnosis delayed over 3 weeks results in chronic infection with necessary bone resection |
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tetanus prophylaxis consists of what 4 components
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-wound care
-tetanus toxoid -immune globulin -abx |
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how often should tetanus boosters be administered
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-when last injection was greater then 1 yr and the wound is tetanus prone; give the booster
-if the wound is not tetanus prone, booster should be given every 5 yrs |
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MC encountered foreign body in the foot
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pin or needle
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necrotic arachnidism - clinical progression and cause
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-brown recluse of genus Loxosclese
-severe necrotic tissue destruction -blue gray halo peri wound -progresses to necrosis, eschar foration and large ulceration |
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tx for brown recluse bite
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-controversial
-but intralesional and oral steroids, surgical debridement and use of dapsone |
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diff between low velocity and high velocity trauam
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-low is <2000 ft/sec
-high is >2000 ft/sec |
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what formula describes the amt of energy posessed by a projectile
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KE = 1/2 mv ^2
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describe the classificationn for shotgun wounds and name its developers
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sherman and parrish
1 - penetrates subcut tissue or deep fascia, occur at distance greater then 7 yards 2 - occur at 3-7 yards; viscera bones and vascular system violated 3 - occur at less then 3 yards; severe local destruction and loss of tissue |
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Ordogs classification for gunshot wounds
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0 - no injury
1 - blunt injury (non penetrating gunshot wound) 2 - graze injury 3 - blast effect w/o missile penetration 4 - blast effect with missile penetration 5 - penetrating 6 - perforating 7 - penetration with missile embolization |
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lead intoxication
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plumbism
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abx of choice for type 1 gunshots
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cephalosporin
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is cavitation associated with low or high velocity gunshot wounds
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high velocity
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classification for burn injury
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1st degree - sunburn, partil thickness
2 - blister formation, into deep epidermis 3 - full thickenss, leathery |
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fluid replacement for first 24 hours after a burn
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Baxters formula
-4 ml crystalloid per percent of total body surface area per kg of weight |
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describe the stages of skin graft healing
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1. plasmatic
2. inosculation 3. revascularization 4. reinervation |
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what is the number of organisms per gram of TISSUE that define infection
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10^5
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what is the number of organisms per gram of BONE that define infection
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10^6
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what is the number of organisms per gram of bone or soft tissue when a foreign body is present
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10^2
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what are the stages of wound healing and what goes on in each stage
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1. substrate (lag) phase; formation of platelet-fibrin plug and PMN are main WBC
2. proliferation phase; fibroblasts lay down collagen, new vessels cross the defect, presence of myofibroblasts which have contractile ability (macrophage is main cell) -remodeling phase; collagen is realigned |
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MC fracture orientation in a lesser digit
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closed spiral oblique
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why is the area around the ankle prone to formation of fracture blisters
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-lack of epidermal anchoring structures such as hair follicles and swear glands
-extensive veins -sparse subcutaneous tissue -flatter opidermal papillae |
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what locations other then the foot are prone to fracture blister formation
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elbow
distal tibia |
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what are 2 types of fracture blisters
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clear (serous) - more common
hemorrhagic - common in more severe injuries |
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between what two skin layers do fracture blisters form
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dermal-epidermal jxn
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osteochondrosis of the base of the phalanges
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theimans
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what are two broad catergories of compartment syndrome etiology
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-those that cause increase in compartment contents
-those that cause decrease in compartment size |
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MC etiology of compartment syndrome
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fracture
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name the compartments of the foot
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-medial
-lateral -central -interosseous |
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what percentage of nail plate should be invovled with sunungual hematoma before a nail is avulsed
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-greater then 25%
-any lacerations should be repaired with fine suture -check for nail bed lacerations when over 25% of nail bed is involved |
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what % of puncture wounds to the bottom of the foot develop complications
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10%
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what percentage of complications following puncture wounds to the bottom of the foot develop OM
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<2%
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when should you use tetanus immunoglobulin following a puncture wound to the foot
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-in a case where basic active immunity has not been attained or where it has been attained but is greater then 10 yrs old and no boosters given since then; and the wound is very dirty and tetanus prone
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in terms of trauma, what does the "golden period" refer to
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the first 6-8 hour after an injury before significant contamination developes
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