Foot and Ankle Trauma Diagnosis Quiz
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Questions and Answers

What is the goal of treatment for Charcot deformity?

  • To predict the occurrence of future Charcot events
  • To avoid surgical intervention at all costs
  • To stabilize the foot and enable functional ambulation (correct)
  • To achieve mobility without the need for footwear

    • What type of fixation is recommended by AO Principles for Foot and Ankle Trauma?

  • Flexible external distraction fixation
  • Rigid internal compression fixation (correct)
  • Loose external stabilization fixation
  • Dynamite internal compression fixation

    • Why is MRI considered useful in the early stages of Charcot deformity?

  • To explore the emotional state of the patient
  • To plan for immediate surgical intervention
  • To identify increased inflammation (correct)
  • To predict the exact time of surgery

    • What is the typical imaging modality needed for diagnosing foot and ankle trauma?

    <p>Radiographs</p> Signup and view all the answers

    Which principle is mentioned as difficult to adhere to in surgical Charcot management?

    <p>Rigid internal compression fixation</p> Signup and view all the answers

    What complication type arises from wire or pin insertion during midfoot Charcot reconstructions?

    <p>Vascular Acute trauma from wire or pin insertion</p> Signup and view all the answers

    Which complication type could result in skin loss in patients undergoing midfoot Charcot reconstructions?

    <p>Impingement</p> Signup and view all the answers

    What type of complication severity is defined as 'Minor' in the context of midfoot Charcot reconstructions?

    <p>Minor</p> Signup and view all the answers

    Why might a midfoot Charcot patient experience a complex rockerbottom deformity?

    <p>Lead to PB dysfunction</p> Signup and view all the answers

    Which type of soft tissue complication is particularly concerning for patients undergoing midfoot Charcot reconstructions?

    <p>Infection - superficial, deep, abscess</p> Signup and view all the answers

    In the context of midfoot Charcot reconstructions, what can prevent hardware failure and provide additional stability?

    <p>Subtalar joint fusion</p> Signup and view all the answers

    What is stated about the usefulness of combining radiographic/functional and anatomical classifications in Charcot foot treatment?

    <p>Combining both classifications is more useful in guiding surgical treatment options.</p> Signup and view all the answers

    What is a part of the initial diagnostic evaluation for Charcot foot?

    <p>Obtaining a flatfoot series of radiographs.</p> Signup and view all the answers

    What imaging method is recommended for distinguishing Charcot foot from osteomyelitis?

    <p>CT with 3D reconstruction</p> Signup and view all the answers

    Are there standard algorithms for treating Charcot deformities?

    <p>No set algorithm, instead various approaches by different experts with success.</p> Signup and view all the answers

    When is limb preservation considered in Charcot foot treatment?

    <p>Dependent on the comfort and skill level of the treating surgeon.</p> Signup and view all the answers

    In Charcot foot treatment, what is the recommended method to evaluate if the patient can be managed conservatively?

    <p>Evaluate the soft tissue envelope.</p> Signup and view all the answers

    What is the defining characteristic of Moderate Complications in external fixation procedures?

    <p>Requires more invasive care and additional surgical procedures</p> Signup and view all the answers

    Which of the following is an example of a Major Complication in external fixation procedures?

    <p>A change required in the index procedure treatment plan</p> Signup and view all the answers

    What type of care is typically needed to resolve issues related to Moderate Complications?

    <p>More invasive care and potential surgery</p> Signup and view all the answers

    In which case is admission to a hospital or outpatient surgical setting typically required?

    <p>A Major Complication necessitating a change in the index procedure treatment plan</p> Signup and view all the answers

    Which of the following resolves a Moderate Complication in external fixation procedures?

    <p>IV antibiotics for pin tract infection</p> Signup and view all the answers

    What is the most common complication reported for patients undergoing external fixation?

    <p>Wound Dehiscence</p> Signup and view all the answers

    Which group had a 7-fold risk for wire complications compared to the other group?

    <p>Diabetic patients</p> Signup and view all the answers

    What is considered a major complication according to the study?

    <p>Pin fracture requiring wire exchange</p> Signup and view all the answers

    How many patients developed pin tract infection in the study of pin care?

    <p>5</p> Signup and view all the answers

    What is the key treatment goal for patients with Charcot foot?

    <p>Achieving a plantigrade braceable foot</p> Signup and view all the answers

    What technique in the operating room can help avoid complications during external fixation?

    <p>Application of pins and wires in a safe zone</p> Signup and view all the answers

    What is the recommended treatment goal, whether surgical or non-surgical, for Charcot deformity?

    <p>Achieve a stable and plantigrade foot for functional ambulation</p> Signup and view all the answers

    What is the significance of early pain-free mobilization in Charcot management according to AO Principles?

    <p>It prevents deformity progression</p> Signup and view all the answers

    Why can it be challenging to adhere to AO Principles for surgical Charcot management?

    <p>Patients often have poor compliance with post-operative care</p> Signup and view all the answers

    What is the goal when determining whether surgery is necessary for Charcot deformity?

    <p>Achieve a stable and plantigrade foot for ambulation</p> Signup and view all the answers

    Why is MRI considered potentially useful in the early stages of Charcot deformity?

    <p>To assess inflammation levels</p> Signup and view all the answers

    What is one of the common reasons mentioned in the literature to operate on Charcot arthropathy?

    <p>Failed ulcer treatment despite offloading</p> Signup and view all the answers

    When is surgery considered in the course of Charcot arthropathy?

    <p>Only during the quiescent stages</p> Signup and view all the answers

    In the study by Sheldon Simon et al, what method was compared to non-operative management for Charcot arthropathy?

    <p>Arthrodesis vs. fusion</p> Signup and view all the answers

    What is the primary focus of the Charcot arthropathy literature mentioned in the text?

    <p>Controversy regarding early surgical intervention</p> Signup and view all the answers

    What is a factor that influences the goals of treatment for Charcot arthropathy?

    <p>Activity level of the patients</p> Signup and view all the answers

    What parameter was used for comparison in the gait analysis in the study by Sheldon Simon et al?

    <p>Weight distribution in affected vs. unaffected foot</p> Signup and view all the answers

    What is a reason to consider amputating the patient's limb below the knee?

    <p>If the patient is not ready for a long treatment period with expected complications.</p> Signup and view all the answers

    What is the primary difference in surgical approaches between large extensile incisions and minimal incision approaches?

    <p>Incision size and the access provided to bone and joints.</p> Signup and view all the answers

    What is a consideration for fixation during surgical treatment when deciding on screw fixation?

    <p>The bone quality for stable screw fixation.</p> Signup and view all the answers

    In the context of soft tissue reconstruction approaches, what is a reason for considering the minimal incision approach over large extensile incisions?

    <p>Maintaining soft tissue envelopes and accommodating poor tissue quality.</p> Signup and view all the answers

    When is internal fixation typically avoided in areas of infection during surgical treatment?

    <p>When the infection has not been fully eradicated.</p> Signup and view all the answers

    What is a determining factor for choosing external fixation or Intramedullary Nailing in cases of severe hindfoot deformities?

    <p>The amount of deformity correction needed.</p> Signup and view all the answers

    Which treatment approach was associated with a better chance of avoiding surgical intervention in patients with midfoot Charcot arthropathy?

    <p>Utilizing custom depth-inlay shoes</p> Signup and view all the answers

    What was the most common surgical procedure performed in patients requiring surgery for midfoot Charcot arthropathy in the study?

    <p>Corrected osteotomy with attempted fusion</p> Signup and view all the answers

    Which aspect did the author of the study admit to have limitations in determining in the patients with midfoot Charcot arthropathy?

    <p>The classification of a plantigrade foot</p> Signup and view all the answers

    What is the author's opinion on using radiographic/functional versus anatomical classifications for guiding treatment of midfoot Charcot arthropathy?

    <p>A combination of both is preferred for guiding surgical treatment options</p> Signup and view all the answers

    In the study, what was one of the limitations indicated by the author related to the treatment of midfoot Charcot arthropathy with custom shoes or an AFO?

    <p>Author's opinion that it was not a desirable outcome</p> Signup and view all the answers

    Which of the following classifications were stated in the text as NOT being useful on their own to guide treatment for midfoot Charcot arthropathy?

    <p>Combination of radiographic/functional and anatomical classifications</p> Signup and view all the answers

    What is the primary treatment option recommended by the task force members for Charcot Neuroarthropathy (CN) of the ankle after nonsurgical management failures?

    <p>Revision surgery</p> Signup and view all the answers

    According to the study by Wukich et al, what is the increased risk of overall complications for patients with complicated diabetes who experience ankle fractures compared to those with uncomplicated diabetes?

    <p>3.8 times</p> Signup and view all the answers

    In the case presentation, what was the known history of the 51-year-old diabetic male patient?

    <p>Previous left 2nd toe wound leading to successful healing</p> Signup and view all the answers

    What is the key indication for treating patients with diabetic neuropathy and unstable ankle fractures as a Stage O charcot according to Wukich et al's study?

    <p>Ensuring bone union</p> Signup and view all the answers

    What is the significant finding regarding the need for revision surgery/arthrodesis in the group with complicated diabetes according to Wukich et al's study?

    <p>5 times higher likelihood</p> Signup and view all the answers

    What is the recommended duration of Non-Weight-Bearing (NWB) following unstable ankle fractures in patients with diabetic neuropathy according to the study?

    <p>3 months</p> Signup and view all the answers

    What is the process called when tissue with its blood supply is transferred from one part of the body to another?

    <p>Flap reconstruction</p> Signup and view all the answers

    Which soft tissue flap classification system does the text mention as potentially confusing due to the lack of a unified system?

    <p>Anatomic classification</p> Signup and view all the answers

    In flap classification based on composition, what type of flap consists of both skin and fat components?

    <p>Fasciocutaneous flap</p> Signup and view all the answers

    Which of the following properly describes an island flap based on its vascular structure?

    <p>It has a pedicle composed of vascular structures</p> Signup and view all the answers

    What distinguishes a free flap from other axial blood-supplied flaps?

    <p>It requires reanastomosis at the recipient site</p> Signup and view all the answers

    In perforator flaps, what type of vessel serves as the basis for these flaps?

    <p>Artery in the tissue</p> Signup and view all the answers

    Where does the superficial sural artery anatomically anastomose?

    <p>With the peroneal artery</p> Signup and view all the answers

    What does the reverse sural artery flap anatomy involve primarily?

    <p>Fascia piercing by the sural nerve</p> Signup and view all the answers

    Which artery arises from either the popliteal or sural artery and reaches the sural nerve after a short distance?

    <p>Superficial sural artery</p> Signup and view all the answers

    What is the primary conclusion drawn from the anatomic study noted in the text?

    <p>Development of neuro-skin island flap is possible</p> Signup and view all the answers

    In what cases did the application of the discussed concept achieve good results?

    <p>Chronic ulcerations</p> Signup and view all the answers

    What is a main characteristic of the Superficial Sural artery, as described in the text?

    <p>Follows the path of the peroneal nerve throughout the leg</p> Signup and view all the answers

    What is the primary goal when considering the creation of an axial graft?

    <p>To decide on the appropriate treatment for diabetic foot wounds</p> Signup and view all the answers

    Which treatment option is NOT part of the Soft Tissue Reconstructive Ladder for diabetic foot and ankle wounds?

    <p>Primary Intention Skin Equivalent Grafts</p> Signup and view all the answers

    When considering soft tissue reconstruction, what is a feature of distant axial flaps compared to local random flaps?

    <p>They require coverage of a larger defect</p> Signup and view all the answers

    Which method is recommended as a last resort for soft tissue reconstruction in diabetic foot and ankle wounds?

    <p>Primary Closure</p> Signup and view all the answers

    What is the main benefit of using negative pressure wound therapy in diabetic foot and ankle wound management?

    <p>Reduced need for surgical interventions</p> Signup and view all the answers

    Which option best represents an advanced technique listed in the Soft Tissue Reconstructive Ladder for managing diabetic foot and ankle wounds?

    <p>Topical Growth Factors</p> Signup and view all the answers

    What is a primary advantage of using a Reverse Sural Artery Flap in reconstructive surgery?

    <p>Reliable and constant blood supply</p> Signup and view all the answers

    Which anatomical component emerges from the popliteal fossa and lays superficial to the gastrocnemius muscle?

    <p>Medial sural nerve</p> Signup and view all the answers

    What could be a potential disadvantage of using a Reverse Sural Artery Flap?

    <p>Sacrifice of the sural nerve</p> Signup and view all the answers

    Why does the Reverse Sural Artery Flap have a wide arc of rotation?

    <p>Several possible sizes and shapes</p> Signup and view all the answers

    What is a potential issue that could arise in using a Reverse Sural Artery Flap for reconstruction?

    <p>Venous congestion post-op</p> Signup and view all the answers

    Which vessel has its arterial blood flow reversed during the use of a Reverse Sural Artery Flap?

    <p>Peroneal artery</p> Signup and view all the answers

    What is the likely source of the Lateral Calcaneal Artery, as described in the text?

    <p>Posterior Tibial Artery</p> Signup and view all the answers

    What is the primary consequence of surgical debridement for the diabetic female with wound dehiscence as described in the text?

    <p>Full Exposure of Tendon</p> Signup and view all the answers

    What was the result of the bone cultures taken from the diabetic female's operative wound following debridement?

    <p>Negative for Osteomyelitis</p> Signup and view all the answers

    What is the main purpose of the Reverse Sural Artery Flap according to the text?

    <p>Soft Tissue Reconstruction</p> Signup and view all the answers

    In the context of the described case, what occurs at the donor site after raising the flap?

    <p>Granulation and Staging</p> Signup and view all the answers

    What distinguishes the Immediate Split Thickness Skin Graft option at the donor site in the case described?

    <p>Less Prominent Lateral Heel Dell</p> Signup and view all the answers

    What is the defining characteristic of a perforator flap?

    <p>Main blood supply is a named perforating artery</p> Signup and view all the answers

    In flap composition, what does an Osteo-cutaneous flap include?

    <p>Bone, fascia, subcutaneous tissue, and overlying skin</p> Signup and view all the answers

    What is the distinguishing feature of an Island flap's pedicle?

    <p>Made up of vascular structures dissected from the soft tissue</p> Signup and view all the answers

    Which term describes a flap detached at the vascular pedicle and needing reanastomosis at the recipient site?

    <p>Free flap</p> Signup and view all the answers

    What feature distinguishes a single component muscle flap from an osteo-cutaneous flap?

    <p>Includes bone in addition to muscle</p> Signup and view all the answers

    How does a fasciocutaneous flap differ from a cutaneous flap?

    <p>Includes only skin without subcutaneous tissue</p> Signup and view all the answers

    Where does the superficial sural artery typically arise from?

    <p>The popliteal artery</p> Signup and view all the answers

    What is the key characteristic of the anatomic study discussed in the text?

    <p>Analyzed the course of the saphenous nerve</p> Signup and view all the answers

    In the discussion of the Reverse Sural Artery Flap, what is the primary function of the superficial sural artery?

    <p>To provide blood supply to the skin of the upper calf</p> Signup and view all the answers

    What is the main outcome from applying the neuro-skin island flap concept to chronic ulcerations discussed in the text?

    <p>Achievement of good results</p> Signup and view all the answers

    Where does the superficial sural artery typically anastomose according to the text?

    <p>With the peroneal artery</p> Signup and view all the answers

    What is the significance of the deep fascia in relation to the sural nerve anatomy?

    <p>Creates a protective barrier around the nerve</p> Signup and view all the answers

    What is a key factor to consider when identifying wounds of the lower extremity for an axial graft?

    <p>Complexity of diabetic foot and ankle wounds</p> Signup and view all the answers

    When selecting a soft tissue reconstructive method, what is a critical distinction between regional axial flaps and local random flaps?

    <p>The origin of the blood supply</p> Signup and view all the answers

    What is a determining factor for choosing between primary closure and split thickness or full thickness skin graft in soft tissue reconstruction?

    <p>The timeline for achieving wound closure</p> Signup and view all the answers

    In the context of wound closure factors, what role does hyperbaric oxygen therapy play?

    <p>Adjunctive treatment during all phases of reconstructive ladder</p> Signup and view all the answers

    What distinguishes distant axial flaps from local axial flaps in soft tissue reconstruction?

    <p>The origin of the blood supply</p> Signup and view all the answers

    What is a critical aspect to consider when using secondary intention for skin equivalent grafts in wound closure?

    <p>Use of topical growth factors</p> Signup and view all the answers

    What are the typical origins of the Lateral Calcaneal Artery?

    <p>Terminal branch of the peroneal artery or from the posterior tibial artery</p> Signup and view all the answers

    What is the standard treatment for wound dehiscence leading to full exposure of tendon with necrosis and infection?

    <p>Necrotic tissue resection and coverage with vascularized skin flaps</p> Signup and view all the answers

    In the case of the diabetic female, what did the bone cultures reveal post-op for wound dehiscence?

    <p>Negative for osteomyelitis</p> Signup and view all the answers

    What are the elements ligated during the careful raising of the flap in the surgical procedure described?

    <p>Lateral Calcaneal Artery, Lesser Saphenous Vein and Sural Nerve</p> Signup and view all the answers

    What surgical procedure is facilitated by the anatomical structure known as the Reverse Sural Artery Flap?

    <p>Soft tissue reconstruction</p> Signup and view all the answers

    According to the provided text, who originally described the Reverse Sural Artery Flap in 1992?

    <p>Masquelet</p> Signup and view all the answers

    In the text, why is delaying the component of Reverse Sural Artery Flap Raise beneficial?

    <p>To reduce the incidence of total flap necrosis</p> Signup and view all the answers

    What is the main reason for raising the medial plantar artery flap superficial to the plantar fascia?

    <p>To protect the plantar neurovascular supply</p> Signup and view all the answers

    According to Shaw and Hidalgo's study, what is a common complication associated with plantar flaps?

    <p>Hematoma</p> Signup and view all the answers

    What did the authors of the study by Baker, Newton, and Franklin describe as a significant outcome of using the medial plantar artery pedicle flap in non-diabetic patients?

    <p>All flaps being viable at follow up</p> Signup and view all the answers

    In the context of complications of axial flaps, what can cause venous congestion in the flap?

    <p>Ischemia to flap</p> Signup and view all the answers

    When applying medical leeches to prevent complications in axial flaps, why should they be disposed of in a biohazard container after feeding?

    <p>To ensure safe disposal and avoid infection</p> Signup and view all the answers

    What is a likely reason for revision being performed at 10 days for the diabetic male in the case involving a calcanectomy?

    <p>Mild abscess and hematoma</p> Signup and view all the answers

    Based on the text, what can be a danger associated with ischemia in axial flaps?

    <p>Skin loss in the flap</p> Signup and view all the answers

    What is a key importance of respecting medical comorbidities in patients with axial flaps?

    <p>To avoid complications like venous congestion</p> Signup and view all the answers

    Why should regular checks of hemoglobin and hematocrit levels be recommended after applying medical leeches to axial flaps?

    <p>To assess perfusion to the flap</p> Signup and view all the answers

    Where does the superficial sural artery usually arise from?

    <p>Popliteal artery</p> Signup and view all the answers

    In the anatomical study mentioned, what defined the development of the neuro-skin island flap?

    <p>Accompanying blood supply to skin</p> Signup and view all the answers

    What characterizes the reverse sural artery flap anatomy?

    <p>Anastomoses with the peroneal artery</p> Signup and view all the answers

    Where does the superficial sural artery give off small branches in the lower 2/3 of the leg?

    <p>Sural nerve</p> Signup and view all the answers

    Which artery does the superficial sural artery follow closely in its course?

    <p>Popliteal artery</p> Signup and view all the answers

    What anatomical feature of the superficial sural artery allows it to give off small branches regularly to the sural nerve?

    <p>Position relative to the deep fascia</p> Signup and view all the answers

    Which muscle classification has one dominant pedicle at the origin with minor pedicles entering the muscle belly?

    <p>Type III</p> Signup and view all the answers

    For what purpose are Type IV muscle flaps primarily used in lower leg wounds?

    <p>Large soft tissue defects</p> Signup and view all the answers

    Which muscle flap can be employed for foot and small ankle deficits and has a dominant proximal pedicle?

    <p>Abductor hallucis</p> Signup and view all the answers

    What is the primary point of rotation for the Peroneus Brevis muscle flap?

    <p>Tip of the fibula</p> Signup and view all the answers

    Which muscle classification is characterized by one dominant pedicle at the origin with several smaller secondary pedicles at insertion?

    <p>Type V</p> Signup and view all the answers

    What distinguishes Type II muscle flaps from Type IV muscle flaps in terms of vascularity?

    <p>Dominate proximal pedicle with minor pedicles entering muscle belly</p> Signup and view all the answers

    What surgical procedure was performed on a diabetic female leading to wound dehiscence and tendon exposure as described in the text?

    <p>Insertional Achilles tendon repair</p> Signup and view all the answers

    From which artery does the Lateral Calcaneal Artery typically branch off, as noted in the text?

    <p>Peroneal artery</p> Signup and view all the answers

    What is the classification of a flap that contains skin, muscle, fascia, subcutaneous tissue, and overlying skin?

    <p>Musculocutaneous flap</p> Signup and view all the answers

    What method was used to treat the diabetic female's wound before it progressed to tendon exposure and infection?

    <p>Local wound care and skin grafting</p> Signup and view all the answers

    In soft tissue flap classification, a flap based on named vessels entering the base of the flap and running along its axis supports tissue known as what?

    <p>Angiosome</p> Signup and view all the answers

    What was the outcome of the bone cultures taken during the treatment of the diabetic female's wound?

    <p>Negative for osteomyelitis</p> Signup and view all the answers

    Which nerve is typically ligated during the careful dissection phase of flap surgery described in the text?

    <p>Sural nerve</p> Signup and view all the answers

    Which flap classification is characterized by having no specific or named vessel as its blood supply?

    <p>Random flap</p> Signup and view all the answers

    What is the key differentiating factor between a free flap and a peninsular flap?

    <p>Pedicle structure</p> Signup and view all the answers

    What technique is employed in managing the donor site post raising a flap, as highlighted in the text?

    <p>Immediate skin grafting</p> Signup and view all the answers

    Which is the correct definition of a fasciocutaneous flap compared to other flap compositions?

    <p>Skin, fascia, subcutaneous tissue</p> Signup and view all the answers

    What is a defining characteristic of an osteocutaneous flap in terms of composition?

    <p>Bone, fascia, subcutaneous tissue</p> Signup and view all the answers

    What is a significant advantage of using the Reverse Sural Artery Flap?

    <p>Can be performed as a single stage procedure</p> Signup and view all the answers

    Which structure emerges from the popliteal fossa along with the Median Sural Artery and Small Saphenous Vein as part of the Reverse Sural Artery Flap components?

    <p>Medial Sural Nerve</p> Signup and view all the answers

    In what way does the Reverse Sural Artery Flap use arterial blood for the flap reconstruction?

    <p>Blood enters the sural artery via perforators</p> Signup and view all the answers

    What major drawback is associated with the Reverse Sural Artery Flap based on the description?

    <p>Sacrifice of sural nerve</p> Signup and view all the answers

    How does venous congestion typically manifest in post-operative stages following a Reverse Sural Artery Flap reconstruction?

    <p>Skin slough with incorporation of deep fascia layer</p> Signup and view all the answers

    Why does the Reverse Sural Artery Flap have a wide arc of rotation, and what issue might arise due to this characteristic?

    <p>Allowing for various sizes and shapes for defect coverage, potentially complicating below-knee amputations</p> Signup and view all the answers

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