Surgical Techniques and Conditions Quiz

Questions and Answers

How much shortening is acceptable for the Lapidus procedure?

0.5cm

In Lapidus surgery, if 0.5-1 cm shortening occurs, what should you do?

Plantar flex first metatarsal

With Lapidus surgery, if shortening is greater than 1 cm, what additional procedure should you do?

Weil osteotomies on 2nd/3rd or add bone graft

Osteomyelitis demonstrates radiographic changes after how much bone resorption?

40-70% Signup and view all the answers

At what age is Kohler disease typically identified?

6-9 years old Signup and view all the answers

What is the mechanism of injury (MOI) for peroneal tendon subluxation?

Inverted while the foot is in dorsiflexion Signup and view all the answers

What is the Logriscino procedure?

(Reverdin, CBWO); double osteotomy that corrects moderate to severe IM and increased PASA Signup and view all the answers

Appropriate INR before elective surgery is ____ per day for more than 3 weeks.

20mg Signup and view all the answers

How do you manage a patient on steroids greater than 20mg a day for 3 weeks?

50mg of steroids before incision and then 25mg every 8 hours post-operatively Signup and view all the answers

Hold pre-mixed insulin if blood glucose falls below what level on the morning of surgery?

120mg/dl Signup and view all the answers

What is a potassium level of 2.9 at risk for?

Paralytic ileus Signup and view all the answers

What are the treatments for low potassium (K+)?

Glucose + insulin Signup and view all the answers

What is the maximum dose of protamine sulfate to reverse heparin?

50mg Signup and view all the answers

What percentage of the original length of the metatarsal should not be exceeded during gradual correction of brachymet?

40% Signup and view all the answers

What is the initial test for HIV?

Elisa Signup and view all the answers

What is the second test for HIV?

Western blot Signup and view all the answers

What is the best conscious sedation for closed reduction of an ankle fracture with no known PMH?

Fentanyl + midazolam Signup and view all the answers

How long before surgery should aspirin be held?

7 to 10 days Signup and view all the answers

How long does it take for Coumadin to become therapeutic?

3-5 days Signup and view all the answers

What is the half-life of Plavix?

6 hours Signup and view all the answers

When inserting a partially threaded screw across an osteotomy, what causes distraction instead of compression?

Screw threads within proximal and distal fragments Signup and view all the answers

What is the incision location for gastrocnemius recession?

Posterolateral incision more than 14cm above the calcaneal tuberosity to avoid the sural nerve Signup and view all the answers

What describes an anechoic, dark lesion on ultrasound?

Ganglion cyst Signup and view all the answers

Where should the posterior portal be placed for ankle arthroscopy?

6 to 7mm from the tibial nerve and 3 to 4mm from the sural nerve Signup and view all the answers

An achilles rupture is considered a chronic injury if the delay is greater than how many weeks?

4 weeks Signup and view all the answers

When performing a triple arthrodesis, what is the preferred position of the subtalar joint (STJ)?

5 degrees of valgus, neutral for the transverse tarsal joint Signup and view all the answers

Where does the lateral extensile approach for displaced calcaneal fracture begin?

2cm proximal to the lateral malleolus Signup and view all the answers

When should Etanercept be discontinued before major surgeries?

2 weeks prior Signup and view all the answers

What is the most frequent histological diagnosis found in soft tissues?

Synovial sarcoma Signup and view all the answers

What represents small round blue cells in pathology?

Ewing's sarcoma Signup and view all the answers

In which direction is the fibula most unstable?

Anterior to posterior Signup and view all the answers

What injuries are commonly associated with the antiglide plate for lateral malleolus fractures?

Peroneus brevis Signup and view all the answers

What is the most common surgical incision to correct clubfoot?

Cincinnati incision Signup and view all the answers

What is a common complication following partial fifth ray amputation?

Heterotopic ossification Signup and view all the answers

What is a common complication following talar neck open reduction and internal fixation (ORIF)?

Post-operative varus malunion Signup and view all the answers

Where is the location of the nutrient artery in the metatarsal?

Lateral cortex of the midshaft of the metatarsal in the distal direction Signup and view all the answers

What is the primary source of circulation to the first metatarsal?

First dorsal metatarsal artery Signup and view all the answers

What radiograph is taken in the dorsoplantar view with a plantar-flexed first ray?

Distal to the metatarsal head Signup and view all the answers

Study Notes

Lapidus Procedure

Shortening of up to 0.5 cm is acceptable during the Lapidus procedure.
If shortening occurs between 0.5-1 cm, plantar flexion of the first metatarsal is recommended.
For shortening greater than 1 cm, consider Weil osteotomies on the 2nd/3rd metatarsals or add a bone graft.

Osteomyelitis

Radiographic changes indicative of osteomyelitis occur after 40-70% bone resorption.

Kohler Disease

Most commonly identified in children aged 6-9 years.

Peroneal Tendon Subluxation

Mechanism of injury involves foot inversion while in dorsiflexion.

Logriscino Procedure

Involves a double osteotomy to correct moderate to severe intermetatarsal (IM) angles and increased proximal articular set angle (PASA).

Surgical Management Considerations

For patients on steroids over 20 mg daily for more than 3 weeks, administer 50 mg before incision, followed by 25 mg every 8 hours postoperatively.
Hold pre-mixed insulin if blood glucose drops below 120 mg/dl on the morning of surgery.
Potassium level of 2.9 indicates a risk for paralytic ileus.

Treatment for Low Potassium Levels

Calcium gluconate
Glucose + insulin
Sodium bicarbonate
Calcium resonium
Dialysis

Heparin Reversal

Maximum dose of protamine sulfate for reversing heparin is 50 mg.

Lengthening Procedures

Gradual correction of brachymetatarsia should not exceed 40% of the original metatarsal length.

HIV Testing

Initial test for HIV is the ELISA test, confirmed by Western blot test.

Anesthesia Options

Best conscious sedation for closed reduction of an ankle fracture with no known past medical history includes fentanyl and midazolam.

Pre-surgery Medication Management

Aspirin should be withheld for 7 to 10 days prior to surgery.
Coumadin takes 3-5 days to become therapeutic.

Additional Medication Information

Half-life of Plavix is approximately 6 hours.

Screw Insertion Techniques

Partially threaded screws cause distraction if screw threads are within both proximal and distal fragments.

Surgical Approaches

Gastroc recession incision should be 14 cm above the calcaneal tuberosity, avoiding the sural nerve.
Lateral extensile approach for displaced calcaneal fractures begins 2 cm proximal to the lateral malleolus.

Medication Guidelines for Major Surgeries

Discontinue Etanercept at least 2 weeks prior to major surgeries.

Histological Diagnoses

Synovial sarcoma is the most frequent diagnosis in soft tissues.
Ewing's sarcoma is characterized by small round blue cells.

Fibula Stability

Most unstable in an anterior to posterior direction.

Injuries and Incisions

Antiglide plates are used for lateral malleolus fractures with common injury to the peroneus brevis.
Common surgical incision for clubfoot correction is the Cincinnati incision.

Complications of Surgeries

Common complication after partial fifth ray amputation is heterotopic ossification.
Postoperative varus malunion is a complication following talar neck open reduction and internal fixation (ORIF).

Vascular Supply

Nutrient artery located in the lateral cortex of the metatarsal’s distal midshaft.
First dorsal metatarsal artery is the primary source of circulation to the first metatarsal.

Radiographic Views

Dorsoplantar radiographs show observations distal to the metatarsal head when the first ray is plantar-flexed.

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Description

Test your knowledge on various surgical procedures and medical conditions such as the Lapidus procedure, osteomyelitis, and Kohler disease. This quiz covers critical aspects of surgical management and relevant patient considerations. Perfect for students and professionals in the medical field.