Podiatric Surgical Emergencies Quiz
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Questions and Answers

What are 5 podiatric surgical emergencies?

  1. Infection with emphysema (gas gangrene), 2. Open fracture/dislocation, 3. Compartment syndrome, 4. Necrotizing fasciitis, 5. Neurovascular compromise.

What is the mainstay treatment of open fractures?

  1. Incision and Drainage, 2. Copious Lavage, 3. Eventual reduction and fixation of the fracture.

Describe the Gustilo-Anderson Classification of Open Fractures I.

Clean wound 5cm in diameter with extensive soft tissue damage and adequate soft tissue coverage.

Describe the Gustilo-Anderson Classification of Open Fractures IIIB.

<p>Extensive soft tissue damage with periosteal stripping and massive contamination, cannot reapproximate soft tissue coverage.</p> Signup and view all the answers

Describe the Gustilo-Anderson Classification of Open Fractures IIIC.

<p>Extensive soft tissue damage with periosteal stripping and massive contamination, cannot reapproximate soft tissue coverage, with arterial damage requiring primary repair.</p> Signup and view all the answers

What are the mainstays of foreign body/puncture wound treatment?

<p>Tetanus status, antibiotics, aggressive I&amp;D with copious lavage.</p> Signup and view all the answers

What are the intermetatarsal compartments of the foot?

<p>Contains the interossei muscles.</p> Signup and view all the answers

What is the medial compartment of the foot?

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

What is the lateral compartment of the foot?

<p>Abductor digiti minimi.</p> Signup and view all the answers

What is the superficial central compartment of the foot?

<p>FDB (Flexor digitorum brevis).</p> Signup and view all the answers

What is the deep central compartment of the foot?

<p>Adductor hallucis.</p> Signup and view all the answers

What is contained in the calcaneal compartment of the foot?

<p>Quadratus plantae and lateral plantar artery.</p> Signup and view all the answers

What is contained in the dorsal compartment of the foot?

<p>EDB (Extensor digitorum brevis), EHB (Extensor hallucis brevis).</p> Signup and view all the answers

What are the 7 'P's' of compartment syndrome?

<p>Pain out of proportion, paralysis, pain with passive dorsiflexion of the toes, pulselessness, paresthesia, pressure, pallor.</p> Signup and view all the answers

What is a Beau's Line?

<p>A transverse groove often associated with nail trauma.</p> Signup and view all the answers

Which nerves are involved in intermetatarsal neuromas?

<p>Plantar.</p> Signup and view all the answers

What is Ilfeld's Disease?

<p>Agenesis of the fibular sesamoid.</p> Signup and view all the answers

What is the Vassal Principle?

<p>Adjacent fractures generally improve alignment after reduction of the initial fracture because soft tissue structures are returned to their normal position through traction.</p> Signup and view all the answers

What is the maximum amount of displacement without the need for ORIF?

<p>2mm.</p> Signup and view all the answers

What are 4 reasons to re-admit a post-op patient?

<ol> <li>Uncontrollable pain, 2. Uncontrollable nausea, 3. Medical monitoring is necessary, 4. Dizziness, weakness, cannot ambulate.</li> </ol> Signup and view all the answers

What anesthetic can be safely used in cardiac and asthmatic patients?

<p>Etomidate.</p> Signup and view all the answers

What are the Eikenholtz Stages to Charcot Neuropathy?

<p>Stage 0 - Pre-Charcot Neuropathy, Stage 1 - Fragmentation/Development, Stage 2 - Coalescence, Stage 3 - Remodeling/Reconstruction.</p> Signup and view all the answers

What are the phases of wound healing?

<p>Inflammatory phase, proliferative phase, remodeling phase.</p> Signup and view all the answers

What are the phases of inflammation?

<p>Inflammatory response, repair and regeneration, remodeling and maturation.</p> Signup and view all the answers

What are the 4 overlapping stages of bone healing?

<p>Inflammation, soft callus, hard callus, remodeling.</p> Signup and view all the answers

What are the 2 types of bone healing?

<p>Primary (Haversian Remodeling) and secondary (Callus Formation).</p> Signup and view all the answers

What is the Frykberg Classification of Charcot Neuropathy?

<p>1 - FF/MtPJ, 2 - Midfoot/LisFranc joint, 3 - Tarsal/Choparts joints, 4 - Ankle/STJ, 5 - Calcaneus.</p> Signup and view all the answers

What are 3 causes of diabetic foot ulcers?

<ol> <li>Sensory Neuropathy, 2. Motor Neuropathy, 3. Autonomic Neuropathy.</li> </ol> Signup and view all the answers

What are the surgical layers of dissection?

<ol> <li>Skin, 2. Superficial Fascia, 3. Deep Fascia, 4. Periosteum, 5. Bone.</li> </ol> Signup and view all the answers

What is included in the Waldvogel and Lew Classification?

<ol> <li>Periostitis: Inflammation of the periosteum, 2. Osteitis: Inflammation of the cortex, 3. Osteomyelitis: Inflammation of the medullary canal.</li> </ol> Signup and view all the answers

What is the Johnson and Strom Stage I?

<p>Swelling and pain at the medial ankle, PTP of the PTT, tenosynovitis, normal osseous alignment on x-rays.</p> Signup and view all the answers

What is the Johnson and Strom Stage IIa?

<p>Flexible deformity, FF abducted/too many toes sign, rearfoot valgus, elongation/degeneration of PTT, may be able to do a single heel rise.</p> Signup and view all the answers

What is the Johnson and Strom Stage IIb?

<p>All of the above, no single heel rise, most importantly: subfibular impingement.</p> Signup and view all the answers

What is the Johnson and Strom Stage III?

<p>Rigid deformity, FF varus (10-15 degrees varus without compensation), RF valgus cannot reduce when the patient is NWB, lateral ankle pain and swelling with medial ankle swelling continuing.</p> Signup and view all the answers

What is the Johnson and Strom Stage IV?

<p>Ankle valgus, prolonged valgus eventually overloads the deltoid ligament, findings of Stage III in addition to lateral ankle pain and arthritis.</p> Signup and view all the answers

What is the Conti Classification of PTTD Stage Ia?

<p>Tenosynovitis with 1 or 2 fine longitudinal splits.</p> Signup and view all the answers

What is the Conti Classification of PTTD Stage Ib?

<p>Tenosynovitis with increased number of splits and increased fibrosis.</p> Signup and view all the answers

What is the Conti Classification of PTTD Stage II?

<p>Narrower tendon signal with intramural degeneration and bulbous tendon in the diseased segment.</p> Signup and view all the answers

What is the Conti Classification of PTTD Stage IIIa?

<p>Diffuse synovial swelling and prominent, uniform degeneration.</p> Signup and view all the answers

What is the Conti Classification of PTTD Stage IIIb?

<p>Completely ruptured, replaced with scar tissue in the gapped sections.</p> Signup and view all the answers

What are the stages of arterial occlusion?

<ol> <li>Intermittent Claudication, 2. Rest pain, 3. Ischemia/Gangrene.</li> </ol> Signup and view all the answers

What are the nerves in an ankle block?

<ol> <li>Tibial n, 2. Saphenous n, 3. Medial dorsal cutaneous n, 4. Intermediate dorsal cutaneous n, 5. Deep peroneal n, 6. Sural n.</li> </ol> Signup and view all the answers

What are the nerves in a hallux block?

<ol> <li>1st dorsal proper digital n, 2. 1st plantar proper digital n, 3. 2nd dorsal proper digital n, 4. 2nd plantar proper digital n, 5. Deep peroneal n.</li> </ol> Signup and view all the answers

What are the nerves in a Mayo block?

<ol> <li>Saphenous n, 2. Deep peroneal n, 3. Medial dorsal cutaneous n, 4. Medial plantar n.</li> </ol> Signup and view all the answers

What are the nerves in a reverse Mayo block?

<ol> <li>Lateral dorsal cutaneous n (which comes off the sural n), 2. 4th dorsal common digital n, 3. Superficial branch of the lateral plantar n, 4. 4th plantar common digital n.</li> </ol> Signup and view all the answers

What are the muscles innervated by the medial plantar n?

<ol> <li>Abductor hallucis, 2. Flexor digitorum brevis, 3. 1st Lumbrical, 4. Flexor hallucis brevis.</li> </ol> Signup and view all the answers

What are the muscles innervated by the lateral plantar n?

<ol> <li>Abductor digiti minimi, 2. Quadratus plantae (flexor accessorius), 3. Lumbricals 2-4.</li> </ol> Signup and view all the answers

What are the muscles innervated by the deep br of the lateral plantar n?

<ol> <li>Adductor hallucis (both heads), 2. Dorsal interosseous mm 1-3, 3. Plantar interosseous mm 1-2.</li> </ol> Signup and view all the answers

What are the muscles innervated by the superficial br of the lateral plantar n?

<ol> <li>Flexor digiti minimi brevis, 2. 4th dorsal interosseous, 3. 3rd plantar interosseous.</li> </ol> Signup and view all the answers

What are the muscles innervated by the lateral terminal br of the deep peroneal n?

<ol> <li>Extensor digitorum brevis.</li> </ol> Signup and view all the answers

What is Sullivan's Sign?

<p>The toes adjacent to the affected interspace (of a neuroma) may splay apart on weight-bearing.</p> Signup and view all the answers

Where are neuromas commonly located in relation to the deep transverse intermetatarsal ligament?

<p>Plantar.</p> Signup and view all the answers

What are the 3 branches the tibial nerve turns into under the lacinate ligament?

<ol> <li>Medial plantar n, 2. Lateral plantar n, 3. Medial calcaneal n.</li> </ol> Signup and view all the answers

What is Intentional Tremor associated with?

<p>Multiple Sclerosis (MS).</p> Signup and view all the answers

What is Reflex Sympathetic Dystrophy Stage 1?

<p>Acute: days to weeks, constant burning pain, allodynia, hyperalgesia, hyperesthesia, hyperpathia, joint stiffness, limitation of motion, initially warm red and dry skin but that changes to cyanotic cold, and sweaty.</p> Signup and view all the answers

What is the normal NCV time?

<p>Greater than 40 mps.</p> Signup and view all the answers

What is the orientation of the foot during a LisFranc injury?

<p>Plantarflexed and abducted.</p> Signup and view all the answers

What is the most common source of metastatic tumors that end up in bone?

<p>Breast, lung, prostate, kidney, multiple myeloma, thyroid.</p> Signup and view all the answers

What is an absorbable suture?

<p>Cat gut, etc. with chromic (salts) &lt; vicryl &lt; PDS (Polydiaxonone) &lt; Monocryl &lt; Dexon &lt; Maxon.</p> Signup and view all the answers

What is a minimally absorbable suture?

<p>Silk, cotton (both weak, with cotton weaker), nylon (highest knot slippage), polypropylene (least reactive suture), polyester (strong for tendon repair), fiberwire, stainless steel.</p> Signup and view all the answers

What is heloma molle?

<p>Generally found in the 4th interspace, where the head of the proximal phalanx of the 5th digit abuts the base of the proximal phalanx of the 4th digit, creating a hyperkeratotic lesion.</p> Signup and view all the answers

Where should plating be placed on the tension side of a fracture?

<p>Plantar.</p> Signup and view all the answers

Which two sutures are least reactive to skin?

<p>Stainless steel and prolene.</p> Signup and view all the answers

What is the safest inhaled anesthetic in cardiac patients undergoing surgery?

<p>Isoflurane.</p> Signup and view all the answers

Study Notes

Podiatric Surgical Emergencies

  • Key emergencies include gas gangrene, open fractures, compartment syndrome, necrotizing fasciitis, and neurovascular compromise.

Treatment of Open Fractures

  • Main treatment consists of incision and drainage, extensive lavage, followed by reduction and fixation.

Gustilo-Anderson Classification of Open Fractures

  • Class I: Clean wound ≤ 5 cm with soft tissue damage; requires coverage. Antibiotics: Ancef, Clindamycin, Aminoglycoside.
  • Class IIIB: Extensive soft tissue damage and contamination with no possibility of reapproximation.
  • Class IIIC: Similar to IIIB but with arterial damage requiring repair.

Foreign Body and Puncture Wound Treatment

  • Important factors include checking tetanus status, administering antibiotics, and performing aggressive incision and drainage with copious lavage.

Intermetatarsal Compartments of the Foot

  • Comprised of four compartments containing interossei muscles.

Compartments and Associated Muscles

  • Medial Compartment: Abductor hallucis.
  • Lateral Compartment: Abductor digiti minimi.
  • Superficial Central Compartment: Flexor digitorum brevis (FDB).
  • Deep Central Compartment: Adductor hallucis.
  • Calcaneal Compartment: Quadratus plantae and lateral plantar artery.
  • Dorsal Compartment: Extensor digitorum brevis (EDB) and extensor hallucis brevis (EHB).

Compartment Syndrome Symptoms

  • Notable signs encompass pain that is disproportionate and unmanageable with analgesics, paralysis, impassive pain in dorsiflexion, pulselessness, paresthesia, pressure, and pallor.

Beau's Line

  • A transverse nail groove indicating trauma.

Neuromas and Nerve Involvement

  • Intermetatarsal neuromas primarily affect the plantar digital nerves (not common digital nerves).

Ilfeld's Disease

  • Characterized by agenesis of the fibular sesamoid.

Vassal Principle

  • Aligns adjacent fractures after the initial fracture reduction as soft tissue is returned to normal positioning.

Displacement Tolerance

  • A maximum of 2 mm of displacement can be managed without needing open reduction and internal fixation (ORIF).

Post-Operative Readmission Criteria

  • Criteria for readmission include uncontrollable pain, nausea, need for medical monitoring, dizziness, or inability to ambulate.

Anesthetic for Cardiac and Asthmatic Patients

  • Etomidate is the preferred anesthetic.

Eikenholtz Stages of Charcot Neuropathy

  • Stage 0: Pre-charcot.
  • Stage 1: Fragmentation.
  • Stage 2: Coalescence.
  • Stage 3: Remodeling.

Phases of Wound Healing

  • Includes inflammatory, proliferative, and remodeling phases.

Phases of Inflammation

  • Involves an inflammatory response, repair and regeneration, and remodeling and maturation.

Bone Healing Stages

  • Inflammation, soft callus, hard callus, and remodeling constitute the healing process.

Types of Bone Healing

  • Primary (Haversian remodeling) and secondary (callus formation) healing.

Frykberg Classification of Charcot Neuropathy

  • Ranges from foot and metatarsophalangeal (MTJ) involvement to the calcaneus.

Diabetic Foot Ulcers Causes

  • Sensory, motor, and autonomic neuropathies are primary contributors.

Surgical Layers of Dissection

  • Involves skin, superficial fascia, deep fascia, periosteum, and bone.

Waldvogel and Lew Classification

  • Differentiates conditions like periostitis, osteitis, and osteomyelitis with specific definitions and characteristics for each.

Cierny-Mader-Penninck Classification

  • Utilizes anatomic stages from medullary infection to diffuse cortical and medullary canal infection along with physiologic stages reflecting host risk factors.

Johnson and Strom Stages of PTTD

  • Stages I through IV describe progressive symptoms including tenosynovitis, flexible and rigid deformities, and ankle valgus.

Conti Stages of PTTD

  • Progresses from tenosynovitis with fine splits to complete rupture with scar tissue formation.

Arterial Occlusion Stages

  • Includes intermittent claudication, rest pain, and ischemia/gangrene.

Anesthesia in Foot Procedures

  • Ankle blocks utilize various nerves including the tibial and saphenous nerves; hallux blocks focus on proper digital nerves; Mayo blocks include medial plantar/medial dorsal nerves.

Neuromas and Symptoms

  • Neuromas are usually found plantar to the deep transverse intermetatarsal ligament; Sullivan's Sign indicates adjacent toes may spread apart with weight-bearing.

Tibial Nerve Branches under Lacinate Ligament

  • Divides into medial plantar, lateral plantar, and medial calcaneal nerves.

Suture Material Characteristics

  • Absorbable sutures range from cat gut to PDS; minimally absorbable options include silk and stainless steel with varied reactivity and strength characteristics.

Heloma Molle

  • Commonly occurs in the 4th interspace due to pressure from adjacent phalanges, producing a hyperkeratotic lesion.

Fracture Tension Side

  • Tension during healing is managed on the plantar side of metatarsal fractures.

Anesthetics in Cardiac Patients

  • Isoflurane is recognized as the safest inhaled anesthetic option.

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Description

Test your knowledge on key emergencies in podiatric surgery, including gas gangrene and compartment syndrome. This quiz covers treatments for open fractures, classifications, and management of foreign body injuries. Perfect for students and professionals in the field of podiatry.

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