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What kind of graft do you use in a Calcaneal Evans osteotomy?
Allograft!, Autograft is preferred for pretty much everything else
Name of accessory ligament running parrallel and distal to AITFL?
During HT of 5th toe surgery Dr. pointed at the Extensor tendon of 5th toe and asked, "Does the brevis run lateral or medial to the longus?"
Trick question, no brevis tendon going to the 5th toe.
What % of achillies tendon tears which are treated conservatively go on to re-rupture?
Mechanism of action of Colchicine?
inhibits microtubule polymerization which leads to an inhibition of PMNs to the inflammatory site. Dosage is 0.6mg per hour until resolves with a max daily does of 6mg.
Was given an SER-4 fracture and was asked when you have lateral displacement of the talus how much displacement is equivalent to what percent decrease in tibiotalar surface area?
answer is 1mm lateral displacement is a decrease in 42% of surface area.
the non-operative and operative treatment options for calc fractures.
Buckley 2006- it showed that there was no difference in healing between both treatment options (I recommend reading it, easy to read article)
I was asked movements you can use an ankle scope for.
Rotational, sweeping, and Pistoning
I was asked the 4 AO principles
1. Anatomic reduction of fx fragments. 2. Stable Fixation. 3. Preservation of blood supply. 4. Early ROM
I was asked about screw fixation for the Syndesmosis
1 screw piercing 4 cortices or 2 screws piercing 3 corticies
I saw a wound today that showed evidence of pathergy with an underlying vasculitis
My differential for this was Pyoderma Gangrenosum
Why do incisional VACs work?
-Increased Microcirculation, improving angiogenesis and blood flow through capillaries
-Mechanical stretching of cells and collagen deposition, leading to growth and expansion.
What is the mechanism of the Hebert Screw?
-Headless screw with threads at both ends. Creates compression via difference in thread pitch. Prox end has smaller pitch, distal has larger pitch, when it is screwed, the far fragment is brought closer to the near fragment.
In OR, Downey pointed to a Thickening dorsal aspect of 1st MPJ caspsule, and asked "what is this?"
Extensor Hallucis Capsularis
Why are you not overly concerned about mild-mod decreased Na+ levels in diabetics?
As a rule, Na appears low in diabetics called Pseudohyponatremia. For every 100 increase in glucose you decrease about 0.6 points of Na
Why should you be cautious in using NSAIDs in patients with renal failure?
You get decreased vasodilation from the inhibition of prostagladin, which decreases the already limited blood flow into the renal glomular
What is use of tranexamic acid during GA?
Answer = Decrease blood loss during surgery. It is an anti-fibrinolytic. It competitively inhibits the formation of plasminogen to plasmin, thus preventing breakdown of fibrin
What other test can you perform to stress the syndesmosis during ankle fx case (besides Cotton Hook Test)?
External rotation of foot upon leg (as per an Ortho attending) - He stated that literature states the Cotton Hook test is many times unreliable, so external rotation is the preferred method?
I was asked during a Lapidus the size of the medial cuneiform-1st met joint
The joint is 31 mm
What muscle tendon can you see inferiorly after resecting the cartilage for a Lapidus
Positive predictive value for Probe to bone for osteomyelitis
2 articles. 1 states that the PPV is .57 for outpatients. The other states it is .97 for inpatients
5 oral drugs for MRSA
Bactrim, Minocylcine, Doxycycline, Zyvox, and Clindamycin
Where is the watershed area for the posterior tibial tendon start and end?
Distally just proximal to the tibial tuberosity, and ends 13mm proximal to the medial malleolus. It's 14cm in length in total
What are the PO options for Pseudomonas coverage?
There's only one and its Cipro (maybe levo, not sure about that)
Why does heparin induced thrombocytopenia occur?
exposure to heparin (whether it's from sensativity from exposure in vitro or otherwise) that sparks an immune reaction. The IgG recognizes heparin and attaches itself to it and forms an immune complex. This complex interacts with Fc receptors on platelets that leads to potent platelet activation and subsiquent clotting when there should be blood thinning.
What % of talar/tibial articulation is lost with a 1mm lateral shift of the talus?
What is conduction down an axon called? How does local anethesia work in regards to axons?
Saltatory Conduction. Blocks Na channels (blocks depolarization)
What was the conclusion of Bevins-Tomilson Article in Charcot foot deformity?
- They concluded that there was a direct correlation to plantar midfoot ulcerations in Charcot foot deformities with radiographic evidence of a Meary's Angle of -27 degrees or more.
- What is a bayonet deformity?
- Dorsal Dislocation at the TMT Joint seen in Charcot foot deformity
- Who descrtibed the 21 point examination in Ankle Arthroscopy?
- Ferkel, 1993
- Caprosyn suture?
- It is a monofilament, absorbable suture made of Glycolide, Caprolactone, Trimethylene carbonate and Lactile - it is used to close sub-q
- What are 2 indications for Indocin?
- 1. Gout (treats symptoms) 2. Prevents heterotropic ossification (seen typically in total hip replacements)
- What is a Dancer's fracture?
- Distal 5th metatarsal fracture - first described by Hamilton and O'Malley at the Hospital of Special Surgery -> usually don't fixate it
What did Astion state in his article with STJ fusion?
after TNJ fusion, only 8-9% of STJ motion remained. With STJ fusion, approximately 25% of TNJ motion remained and 55% CCJ motion remained.
What position do we want in STJ fusion?
5 degrees of valgus to permit mobility of the TNJ and CCJ
Short thread vs. Long thread
Short thread (16mm) and Long thread (32mm)
What is tension of wires we typically use in leg and foot in external fixation (using Synthes circular fixator)?
Leg - typically 110-130, rearfoot (calcaneus) 90-100, forefoot (70-90) -> this is Dr. Burn's preference
What is the % of someone developing Charcot on the other foot?
What is Basset's Ligament?
Inferior portion of ATFL that can cause soft tissue impingment
What is the prevalence of Peroneus Quartus?
What is a Nancy nail?
IM nail through the fibula
What is the classification for CRPS?
CRSP 1 (previously RSD) - NO confirmed nerve damage; CRPS 2 (Previously causalgia)- confirmed nerve damage
What is the clinical presentation for CRPS?
Foot that is red hot swollen, non-pitting edema, change in skin temperature, decrease in hair, allodynia, hyperalgesia
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