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?
Signup and view all the answers
At what age is Kohler disease typically identified?
Signup and view all the answers
What is the mechanism of injury (MOI) for peroneal tendon subluxation?
Signup and view all the answers
What is the Logriscino procedure?
Signup and view all the answers
Appropriate INR before elective surgery is ____ per day for more than 3 weeks.
Signup and view all the answers
How do you manage a patient on steroids greater than 20mg a day for 3 weeks?
Signup and view all the answers
Hold pre-mixed insulin if blood glucose falls below what level on the morning of surgery?
Signup and view all the answers
What is a potassium level of 2.9 at risk for?
Signup and view all the answers
What are the treatments for low potassium (K+)?
Signup and view all the answers
What is the maximum dose of protamine sulfate to reverse heparin?
Signup and view all the answers
What percentage of the original length of the metatarsal should not be exceeded during gradual correction of brachymet?
Signup and view all the answers
What is the initial test for HIV?
Signup and view all the answers
What is the second test for HIV?
Signup and view all the answers
What is the best conscious sedation for closed reduction of an ankle fracture with no known PMH?
Signup and view all the answers
How long before surgery should aspirin be held?
Signup and view all the answers
How long does it take for Coumadin to become therapeutic?
Signup and view all the answers
What is the half-life of Plavix?
Signup and view all the answers
When inserting a partially threaded screw across an osteotomy, what causes distraction instead of compression?
Signup and view all the answers
What is the incision location for gastrocnemius recession?
Signup and view all the answers
What describes an anechoic, dark lesion on ultrasound?
Signup and view all the answers
Where should the posterior portal be placed for ankle arthroscopy?
Signup and view all the answers
An achilles rupture is considered a chronic injury if the delay is greater than how many weeks?
Signup and view all the answers
When performing a triple arthrodesis, what is the preferred position of the subtalar joint (STJ)?
Signup and view all the answers
Where does the lateral extensile approach for displaced calcaneal fracture begin?
Signup and view all the answers
When should Etanercept be discontinued before major surgeries?
Signup and view all the answers
What is the most frequent histological diagnosis found in soft tissues?
Signup and view all the answers
What represents small round blue cells in pathology?
Signup and view all the answers
In which direction is the fibula most unstable?
Signup and view all the answers
What injuries are commonly associated with the antiglide plate for lateral malleolus fractures?
Signup and view all the answers
What is the most common surgical incision to correct clubfoot?
Signup and view all the answers
What is a common complication following partial fifth ray amputation?
Signup and view all the answers
What is a common complication following talar neck open reduction and internal fixation (ORIF)?
Signup and view all the answers
Where is the location of the nutrient artery in the metatarsal?
Signup and view all the answers
What is the primary source of circulation to the first metatarsal?
Signup and view all the answers
What radiograph is taken in the dorsoplantar view with a plantar-flexed first ray?
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.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
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.